Introduction:
The aim of our study was to investigate availability of smoking cessation products and make comparisons across 15 European partner countries (Albania, Armenia, Belgium, Bulgaria, Georgia, Greece, Italy, Kosovo, Poland, Romania, Russia, Serbia, Slovenia, Spain, Ukraine) of EPACTT-2 (EuroPean Accreditation Curriculum on Tobacco Treatment project) project that aims to develop and expand an accredited curriculum for tobacco treatment dependence.

Methods:
The structured 8-item self-administered questionnaire in English was distributed among partner country representatives for completing. The questionnaire covered availability and price of smoking cessation products, as well as country profiles.

Results:
Fourteen countries (4 lower-middle income, 5 upper-middle income, and 5 high-income) participated in the online survey in 2017. Only Russia and Italy had all the listed smoking cessation products available in the market. Out of the listed six forms of NRT, each lower-middle income country, on average, had 1.5 form of NRT product available in the market. Importantly, Georgia did not have any NRT available. Upper-middle income countries had on average 3.0 form of NRT products available in the market. However, Albania did not have any smoking cessation product available. The most available smoking cessation product other than NRT in lower-middle income and upper-middle income countries was Cytisine. All high income countries had Bupropion, Varenicline and at least 3 NRT products (gum, patch and at least one other form of NRT) available. On average, high income countries had 4.2 form of NRT available. Among high income countries, Cytisine was available only in Italy.

Conclusions:
Despite considerably higher burden of smoking and the evidence based efficacy of NRT and pharmacotherapy in successful smoking cessation, lower-middle income countries have reported limited availability compared to upper-middle and high income countries. Countries should implement actions to make smoking cessation medications available, accessible, and free or at an affordable cost in accordance with Article 14 of WHO FCTC.

Funding:
This study was supported by Global Bridges Healthcare Alliance for Tobacco Dependence Treatment hosted by Mayo Clinic and Pfizer Independent Grants for Learning and Change.