ATTUD Journal Club Postings

Is Face‐to‐Face Counseling Worth It

In my prior entries, I have mentioned the need for studies showing that face‐to‐face counseling is worth the extra cost. Such individual treatment can never be as cost‐effective as less‐intensive treatment. In fact, in medicine there are very few cases where more intensive treatment is more cost‐effective.

Recently, two studies have tested more vs less intensive treatment. In one study, 300 smokers in dental care were randomized to low intensity treatment (one 30 min session) or high intensity treatment (eight 40 min sessions over 4 months‐i.e. 320 min) (BMC Public Hlth 9:121). Continuous abstinence was higher in the high than low intensity treatment (18% vs 9%). So one issue is whether it’s worth spending an extra 290 min (about 5 hr) to increase quit rates by 9%. So assume that that this 9% results in an extra 4% who remain quit their life and these are middle‐aged smokers, let’s assume this will decrease smoking‐related morbidity and mortality by a conservative 2%. Now assume e smoking costs employers about an extra $6000/yr and counseling costs $80/hr (don’t you wish!), then the cost is 5 hr x $80/hr = $400. Since the cost saving is 2% x $6000 = $120, then within 3.5 yrs this cost is paid off.

The other study randomized 772 smokers in a cessation clinic to either phone counseling alone, face‐to­face and combined counseling. There were seven sessions of each and all participants received NRT (Prev Med 57:183). Continuous abstinence at 1 yr was 20% in the phone alone, 28% in face‐to‐face alone and 29% in the combined group. Although the authors did not statistically test individual vs phone, with their sample size, this will be significant. Clearly this shows that in those who are willing to attend face‐to‐face treatment, phone counseling is less effective. This is probably because these smokers smoked about 25 cigs/day (which is high for European smokers) and their FTND was around 6.3 (which is also high) and thus, were likely quite dependent. But it also is evidence that there is a subgroup of smokers who do benefit from face‐to‐face rather than phone treatment, just like the rest of medicine where there are subgroups who do not respond to minimal treatments – after all that is where stepped‐care algorithms were invented. So the real challenge is defining this group.

If 10% of the time, money, and thinking spent on pets or sports were devoted to poverty…