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. 2010 Feb;100(2):341-8.
doi: 10.2105/AJPH.2008.147223. Epub 2009 Dec 17.

Estimating the risks and benefits of nicotine replacement therapy for smoking cessation in the United States

Benjamin J Apelberg  1 , Georgiana Onicescu, Erika Avila-Tang, Jonathan M Samet
Affiliations

Estimating the risks and benefits of nicotine replacement therapy for smoking cessation in the United States

Benjamin J Apelberg et al. Am J Public Health. 2010 Feb.

Abstract

Objectives: To compare potential population-wide benefits and risks, we examined the potential impact of increased nicotine replacement therapy (NRT) use for smoking cessation on future US mortality.

Methods: We developed a simulation model incorporating a Monte Carlo uncertainty analysis, with data from the 2005 National Health Interview Survey and Cancer Prevention Study II. We estimated the number of avoided premature deaths from smoking attributable to increased NRT use, before and after incorporating assumptions about NRT harm.

Results: We estimate that a gradual increase in the proportion of NRT-aided quit attempts to 100% by 2025 would lead to 40,000 (95% credible interval=31,000, 50,000) premature deaths avoided over a 20-year period. Most avoided deaths would be attributable to lung cancer and cardiovascular disease. After we incorporated assumptions about potential risk from long-term NRT, the estimate of avoided premature deaths from all causes declined to 32 000.

Conclusions: Even after we assumed some harm from long-term NRT use, the benefits from increased cessation success far outweigh the risks. However, the projected reduction in premature mortality still reflects a small portion of the tobacco-related deaths expected over a 20-year period.

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Figures

FIGURE 1
FIGURE 1
Estimated cumulative premature deaths avoided in the United States with 100% nicotine replacement therapy use by year 2025 from (a) all causes, (b) lung cancer, (c) other smoking-related cancers, and (d) cardiovascular diseases. Note. Solid line denotes central estimate and dashed line denotes 2.5th and 97.5th percentiles from Monte Carlo uncertainty analysis.
FIGURE 2
FIGURE 2
Density plots of estimated cumulative premature deaths avoided in the United States with 100% nicotine replacement therapy use by year 2025 from (a) all causes, (b) lung cancer, (c) other smoking-related cancers, and (d) cardiovascular diseases. Note. Solid line denotes scenario without assumptions of NRT harm and dashed line denotes scenario with assumption of NRT harm.
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