Discussion
This study tested the effectiveness of simple interventions to prompt smoking cessation delivered to smokers in primary care in North Macedonia. As these were interventions advising smokers to quit, they were delivered to all smokers, regardless of motivation to quit smoking, with the aim of prompting a successful quit attempt. Point estimates indicated that biochemically validated quit rates, self-reported quit rates, motivation to quit, attempts to quit and the proportion reducing the number of cigarettes smoked per day were higher in the CO + VBA arm compared to VBA at all follow up points, whereas point estimates were more inconsistent for the LA + VBA arm. However, it was not possible to draw conclusions about effectiveness of the interventions as the absolute number of participants quitting was lower than expected and estimates were imprecise incorporating the possibility of no effect, with the exception of the proportion who had reduced the number of cigarettes smoked at 4wks and attempts to quit at 12wks in the VBA-CO arm. After taking into account the costs incurred and QALYs gained, the health economic analysis indicated that VBA alone was the dominant intervention (less costly, more effective) however interpretation of this is also limited due to negligible differences in QALYs.