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Reference: Tang, J., & Liao, Y. (2018). Effectiveness of a text messaging-based smoking cessation intervention (Happy Quit) in China: a randomised controlled trial. The Lancet, 392, S6.  https://doi.org/10.1016/S0140-6736(18)32635-7

This week’s paper of the week is brought to you by Dr Tim Wilson, 3V’s Managing Director.

Bottom line, chosen by Tim from the paper

“a mobile phone-based text messaging intervention (Happy Quit), with either high-frequency or low-frequency messaging, is effective to Chinese cigarette smokers. It should be considered for inclusion in smoking cessation services. … One limitation is that we could not prevent participants from using other smoking cessation services.”

Smoking cessations services are generally going to be a higher value intervention, so finding lower cost ways of delivering smoking cessation programmes will increase the value of such a programme. In this paper from The Lancet in October 2018, the authors have conducted a large randomised controlled trial of text messaging to encourage smoking cessation. The participants were randomised to either daily (high frequency), weekly (low frequency) or no messages (control group). The three groups had similar baseline characteristics. At 24 weeks, biochemically verified continuous smoking abstinence was 6·5% in the high-frequency messages group, 6·0% in the low-frequency messages group and 1·9% in the control group. The odds ratio for high-frequency messages vs control 3·51 and for low-frequency messages vs control 3·21, both were statistically significant.

Implications for value-based healthcare

For those of us working in value-based healthcare, there are a number of issues:

  1. Confirmation that there are lower cost, and therefore higher value, means of delivering prevention programmes;
  2. We need to be mindful, when using digital technologies, that we do not worsen inequity and worsen the inverse care law
  3. That the researchers pointed out that they could not limit participants from using other smoking cessation services- this causes a methodological problem for the researchers, although the size of the trial should deal with that. But to increase value overall, it would be necessary to stop lower value interventions when the higher values ones are introduced- not something that health systems are very good at.