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The Top Priority

Building a Better System for Tobacco-Cessation Counseling
      Tobacco use remains the nation’s leading preventable cause of disease and death, each year claiming an estimated 438,000 lives in the United States and accounting for more than $167 billion in healthcare costs and lost productivity.
      Centers for Disease Control and Prevention
      Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001.
      Findings from the National Commission on Prevention Priorities (NCPP), reported in this issue by Maciosek et al.
      • Maciosek M.V.
      • Coffield A.B.
      • Edwards N.M.
      • Flottemesch T.J.
      • Goodman M.J.
      • Solberg L.I.
      Priorities for improving utilization of clinical preventive services results.
      and Solberg et al.,
      • Solberg L.I.
      • Maciosek M.V.
      • Edwards N.M.
      • Khanchandani H.S.
      • Goodman M.J.
      Repeated tobacco-use screening and intervention in clinical practice health impact and cost effectiveness.
      underscore the enormous potential health and economic benefits of addressing this behavior in routine clinical care. Extrapolating from evidence that one-time, brief primary care cessation counseling has a 12-month effectiveness of 2.4% (5.0% when combined with pharmacotherapy), Solberg et al.
      • Solberg L.I.
      • Maciosek M.V.
      • Edwards N.M.
      • Khanchandani H.S.
      • Goodman M.J.
      Repeated tobacco-use screening and intervention in clinical practice health impact and cost effectiveness.
      estimate a 23.1% quit rate from repeated annual screening and brief intervention for tobacco users. Extended over the lifetimes of smokers, the intervention would save 2.47 million quality-adjusted life years at a cost savings of $500 per smoker and billions of dollars for the nation.
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