What's needed for personalized therapy in smoking cessation

It has long been known that smoking cessation is one of the most cost-effective public health opportunities available. The fact that some 22% of Americans smoke,(1) despite overwhelming evidence of the consequences, reflects in part the addictive aspects of smoking and the generally modest effectiveness of various strategies for quitting. Although one of the US Department of Health and Human Services goals for the year 2010 is universal coverage of smoking-cessation agents,(2) only about a third of payers currently cover the cost of such agents.(3) A major disincentive is that the return on investment has been modeled to take at least 5 years to reach the break-even point,(4,5) given the cost of the individual agents, the high recidivism rates, the timeline for influencing outcomes, and the relative ineffectiveness of studied agents in broad or untargeted populations. The article by Patterson et al.(6) in this issue intriguingly suggests that there might be a way to use smokers' phenotypes to determine before treatment initiation which smokers will respond to which therapy. This approach could greatly improve the overall effectiveness of smoking-cessation agents and generate cost savings that might in turn have the effect of influencing more payers to cover these agents.