Nielsen K, Fiore M C
Global Health Outcomes, Glaxo Wellcome Inc., Research Triangle Park, North Carolina 27709-3398, USA.
Prev Med. 2000 Mar;30(3):209-16. doi: 10.1006/pmed.1999.0627.
The nicotine transdermal patch (NTP) has been shown previously to be a cost-effective smoking cessation intervention. This is the first economic analysis comparing the NTP with the only non-nicotine-containing pharmacological intervention, bupropion HCl.
Decision-tree analysis, based on a previously published cost-benefit smoking-cessation model, was used to determine the optimal treatment from the standpoint of costs versus benefits, from the employer's perspective. Base-case probabilities of successful quitting in our model came from clinical trial point-prevalence data at the end of a 1-year follow-up study (N = 893) comparing placebo, bupropion, NTP, and bupropion/NTP in combination, administered along with minimal counseling. Sensitivity analyses were performed to determine the effects of variations in base-case assumptions regarding the monetary benefits that would accrue if an intervention were successful, probabilities of quitting, drug costs, cost of lost work time for a health care provider visit, and cost of the visit itself.
The analysis showed that bupropion is more cost-beneficial than either NTP or bupropion/NTP, with a net benefit in the first post-quit year of up to $338 per employee who attempts to quit compared with $26 for NTP, $178 for the two in combination, and $258 for placebo. These results were robust to most plausible variations in the assumptions used in the model. One exception was the monetary benefit of successful intervention (assumed in the base-case to be $1,654). If this benefit were actually less than $1, 112, placebo (i.e., minimal counseling with no pharmacological intervention) would be more cost-beneficial than any of the active treatments.
From an employer's perspective, bupropion 300 mg/day for 9 weeks is a more cost-beneficial smoking cessation intervention than the nicotine patch, and under most scenarios, bupropion is also more cost-beneficial than placebo.
尼古丁透皮贴剂（NTP）先前已被证明是一种具有成本效益的戒烟干预措施。这是首次将NTP与唯一不含尼古丁的药物干预措施盐酸安非他酮进行比较的经济分析。
基于先前发表的成本效益戒烟模型进行决策树分析，从雇主的角度确定成本与效益方面的最佳治疗方法。我们模型中成功戒烟的基础概率来自一项为期1年的随访研究（N = 893）结束时的临床试验点患病率数据，该研究比较了安慰剂、盐酸安非他酮、NTP以及盐酸安非他酮/NTP联合用药，并辅以最少的咨询。进行敏感性分析以确定基础假设变化的影响，这些假设涉及如果干预成功所产生的货币效益、戒烟概率、药物成本、因就医导致的工作时间损失成本以及就医本身的成本。
分析表明，盐酸安非他酮比NTP或盐酸安非他酮/NTP联合用药更具成本效益，在戒烟后的第一年，每位尝试戒烟的员工的净效益高达338美元，而NTP为26美元，两者联合为178美元，安慰剂为258美元。这些结果对于模型中使用的假设的大多数合理变化具有稳健性。一个例外是成功干预的货币效益（在基础案例中假设为1654美元）。如果该效益实际上低于1112美元，安慰剂（即最少的咨询且无药物干预）将比任何一种积极治疗更具成本效益。
从雇主的角度来看，每天300毫克服用9周的盐酸安非他酮是一种比尼古丁贴片更具成本效益的戒烟干预措施，并且在大多数情况下，盐酸安非他酮也比安慰剂更具成本效益。
