Cost-effective Primary Care-Based Strategies to Improve Smoking Cessation More Value for Money

被引:51
作者
Salize, Hans Joachim [1 ]
Merkel, Silke [1 ]
Reinhard, Iris [1 ]
Twardella, Dorothee [2 ]
Mann, Karl [1 ]
Brenner, Hermann [3 ,4 ]
机构
[1] Cent Inst Mental Hlth, D-68159 Mannheim, Germany
[2] Bavarian Hlth & Food Safety Author, Oberschleissheim, Germany
[3] German Ctr Res Ageing, Heidelberg, Germany
[4] German Canc Res Ctr, D-6900 Heidelberg, Germany
关键词
EFFECTIVENESS ACCEPTABILITY CURVES; RANDOMIZED-TRIAL; INTERVENTIONS; GERMANY; REIMBURSEMENT; NORTRIPTYLINE; BUPROPION; EFFICACY; QUIT;
D O I
10.1001/archinternmed.2008.556
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. Methods: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Results: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, (sic)9.80 or (sic)6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, (sic)92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to (sic)39.10 paid per patient during the trial). In intervention 2, the cost was (sic)82.82, as opposed to (sic)50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; (sic)1 = $1.17.) Conclusions: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.
引用
收藏
页码:230 / 235
页数:6
相关论文
共 27 条
[1]  
BARRETT B, 2003, MENTAL HLTH RES REV, V9, P39
[2]  
Baska T, 2004, EXPERT OPIN PHARMACO, V5, P487, DOI 10.1517/14656566.5.3.487
[3]  
Cummings KM, 2006, J PUBLIC HEALTH MAN, V12, P37
[4]   Efficacy of a cognitive-behavioral program with pharmacological support to achieve smoking cessation [J].
Felten, D ;
Raupach, T ;
Sessler, C ;
Lüthje, L ;
Hasenfuss, G ;
Andreas, S .
DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT, 2006, 131 (05) :197-202
[5]   Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions [J].
Fenwick, E ;
O'Brien, BJ ;
Briggs, A .
HEALTH ECONOMICS, 2004, 13 (05) :405-415
[6]  
GLICK HA, 2001, EXPERT REV PHARMACOE, V2, P89
[7]   The cost-effectiveness of the English smoking treatment services: evidence from practice [J].
Godfrey, C ;
Parrott, S ;
Coleman, T ;
Pound, E .
ADDICTION, 2005, 100 :70-83
[8]   Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation [J].
Hall, SM ;
Lightwood, JM ;
Humfleet, GL ;
Bostrom, A ;
Reus, VI ;
Muñoz, R .
JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH, 2005, 32 (04) :381-392
[9]   The costs and effectiveness of different benefit designs for treating tobacco dependence: Results from a randomized trial [J].
Halpin, Helen Ann ;
McMenamin, Sara B. ;
Rideout, Jeffrey ;
Boyce-Smith, Gifford .
INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING, 2006, 43 (01) :54-65
[10]   Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands [J].
Hoogendoorn, Martine ;
Welsing, Paco ;
Moelken, Maureen P. M. H. Rutten-van .
CURRENT MEDICAL RESEARCH AND OPINION, 2008, 24 (01) :51-61