9 The evidence

9 The evidence

The evidence statements from the reviews provided by external contractors (see What evidence is the guidance based on?) are available in a separate document (see The evidence statements).

This section lists the evidence statements and expert papers, links to the recommendations and sets out a brief summary of findings from the economic analysis.

The evidence statements are short summaries of evidence in a review. Each statement has a short code indicating which document the evidence has come from (see The evidence statements). The letter(s) in the code refer to the type of document the statement is from, and the numbers refer to the document number, and the number of the evidence statement in the document.

For example, evidence statement 1.2.10 indicates that the linked statement is numbered 2.10 in review 1. Evidence statement 2.2.3 indicates that the linked statement is numbered 2.3 in review 2 and evidence statement 3.2.6 indicates that the linked statement is numbered 2.6 in review 3. Evidence statement CE.2.3 indicates that the linked statement is numbered 2.3 in the cost-effectiveness review.

The reviews, expert papers and economic analysis are available online. Where a recommendation is not directly taken from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence).

Recommendation 1: evidence statements 1.1.2.2, 3.1.7, 5.2.7, 5.15.1; expert paper 1

Recommendation 2: evidence statements 1.2.9, 3.1.3, 3.1.7, 3.2.4, 5.2.3, 5.2.7, 5.3.2, 5.3.5, 5.12.1, 5.14.2, 5.15.4, 6.1.2, 7.2.28, CE1.7.0; expert papers 1, 2, 3, 4, 5, 6, 7

Recommendation 3: evidence statements 1.2.9, 1.3.5, 2.1.3, 2.1.5, 2.1.8, 2.1.10, 4.1.1, 4.1.2, 4.4.3, 4.4.4, 4.9.1, 4.9.4, 4.10.1, 4.12.1, 4.13.2, 4.13.2, 5.2.3, 5.3.6, 6.1.5, CE1.1.0, CE1.2.0, CE1.2.1, CE1.2.2, CE1.2.3, CE1.3.0, CE1.6.0, CE1.7.0; expert papers 4, 5, 6, 7

Recommendation 4: evidence statements 1.2.9, 2.2.3, 2.2.9, 3.2.6, CE1.4.0, CE1.4.1; expert papers 3, 4

Recommendation 5: evidence statements 5.2.4, 5.2.8

Recommendation 6: evidence statements 1.1.2.2, 1.1.2.3, 1.3.5, 5.2.1, 5.9.1, 5.9.2, 7.2.28

Recommendation 7: evidence statements 1.1.1.7, 1.1.1.8, 1.1.3.7, 1.2.10, 1.2.31, 1.2.33, 6.3.5, 6.3.6, 7.3.9, 7.3.10

Recommendation 8: evidence statements 3.1.2, 5.3.1, 6.2.2, 7.2.30; expert papers 1, 2, 8; IDE

Recommendation 9: evidence statements 3.1.2, 3.1.3, 3.1.6, 3.2.4, 5.12.1, 5.13.2, 5.14.2, 7.2.28; expert papers 1, 2; IDE

Recommendation 10: evidence statements 3.1.5, 3.2.3, 3.2.6, 5.1.1, 5.8.1, 5.8.1, 5.8.3, 5.15.1, 5.15.4, 7.2.9, 7.2.13, 7.2.30; expert papers 1, 2, 8; IDE

Recommendation 11: evidence statements 3.1.0, 3.1.1, 3.1.5, 3.2.3, 5.1.6, 5.4.2, 5.4.3, 5.5.4, 6.1.2, 6.1.3, 6.1.4, 6.1.5, 6.1.6, 6.1.10, 6.2.1, 6.2.2, 6.2.3, 6.2.5, 6.3.1, 6.3.2, 6.3.3, 6.3.5, 6.3.6, 6.3.8, 7.1.1, 7.2.7, 7.2.10, 7.2.11, 7.2.13, 7.2.15, 7.2.16, 7.2.17, 7.2.18, 7.3.3, 7.3.4, 7.3.8, 7.3.12, 7.3.14; expert papers 6, 8

Recommendation 12: evidence statements 3.1.5, 3.2.3, 5.2.5, 5.2.6, 5.5.2, 6.1.5, 7.2.4, 7.2.18, 7.3.3; expert papers 6, 8; IDE

Recommendation 13: evidence statements 2.1.13, 3.1.0, 5.5.3, 6.2.3, 7.1.2, 7.2.2, 7.2.29

Recommendation 14: evidence statements 3.1.1, 3.1.2, 3.1.3, 3.1.4, 3.2.1, 3.2.2, 3.2.6, 5.1.4, 5.2.5, 5.3.7, 5.4.3, 5.5.1, 5.5.2, 5.5.5, 5.7.1, 5.7.2, 5.7.3, 5.7.4, 5.9.2, 7.2.16, 7.2.17, 7.2.26, 7.3.1, 7.3.3, 7.3.9, 7.3.10; expert papers 2, 8; IDE

Recommendation 15: evidence statement 7.2.8; IDE

Recommendation 16: For relevant evidence statements and expert papers, see recommendations 1, 2, 3, 4, 8, 9, 10, 11 and 12 above.

Economic modelling

The economic model estimates that stop smoking interventions are cost effective for groups of secondary care service users. This includes: pregnant women, patients presenting at secondary care with chronic obstructive pulmonary disease (COPD) and cardiac conditions, pre-operative and general inpatients, and hospital employees.

The same applies to interventions for people with common mental health problems, such as post-traumatic stress disorder (PTSD). In the case of people with schizophrenia, the interventions showed a positive effect in the short term. No impact was observed on 12-month smoking rates. However, the model estimated that there would be potential cost savings in the use of antipsychotics. It demonstrated that if 1 in 10 patients with schizophrenia successfully quit smoking for a year, the interventions would be cost effective.

For the majority of interventions and population groups, the interventions were a cost-effective use of public resources. This holds true not only when the lifetime benefits of smoking cessation are considered, but also when a more short-term perspective is adopted. This means that, for many interventions, the costs needed to deliver them are smaller than the benefits they would generate within the first 3 years of implementation.

As with any modelling exercise, the results are subject to uncertainty and numerous assumptions. However, the sensitivity analysis showed that most interventions remain cost effective even when the costs and effects are randomly varied.

  • National Institute for Health and Care Excellence (NICE)