Javitz Harold S, Swan Gary E, Zbikowski Susan M, Curry Susan J, McAfee Timothy A, Decker Donna, Patterson Richard, Jack Lisa M
Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
Value Health. 2004 Sep-Oct;7(5):535-43. doi: 10.1111/j.1524-4733.2004.75005.x.
The net benefit (i.e., benefits minus costs) of sustained-release (SR) bupropion for smoking cessation from an employer's perspective has previously been evaluated in clinical trials including frequent, in-person behavioral counseling and manufacturer recommended dosing but not in actual practice settings and lower dosing.
The objective of this research was to determine the return on investment (ROI) and internal rate of return (IRR) from an employer's perspective of two dosing schedules of bupropion SR in combination with behavioral interventions of minimal intensity (tailored mailings, TM) or moderate intensity (proactive telephone calls, PTC) in an actual practice setting.
An open-label, randomized trial with 1-year follow-up was conducted in a large health system (Group Health Cooperative) based in Seattle, WA. Participants included 1524 adult smokers interested in quitting smoking. Participants were randomly assigned to receive 150 mg of bupropion SR daily and PTC (n=382), 150 mg of bupropion SR daily and TM (n=381), 300 mg of bupropion SR daily and PTC (n=383) or 300 mg of bupropion SR daily and TM (n=378). Sufficient medications for 8 weeks of dosing were provided to patients. The primary outcome measure of the field trial was self-reported point-prevalence 7-day nonsmoking status at 12 months, and the primary outcome measures of the economic analysis were employer net benefit, employer ROI, and the ROI-associated IRR using 2002 dollars.
Using net benefit, the 300-mg/PTC and the 150-mg/PTC treatments were approximately equally preferred. Using ROI or IRR, both the 150-mg/TM and 150-mg/PTC treatments were about equally preferred, with IRR values of 31.7% and 31.4%, respectively. Under a pessimistic scenario regarding effectiveness and costs, 150 mg/PTC became more cost-effective than 150 mg/TM, and employer IRR for 150 mg/PTC was 13%. Under an optimistic scenario IRR exceeded 45% for all treatments.
These results suggest that employers can receive competitive returns on investment from sponsoring smoking cessation programs, that 150 mg of bupropion doses yield better returns than 300-mg doses, and that PTC treatments should be preferred to TM if smoking cessation rates in the targeted employee population are lower than those in the study population.
从雇主的角度来看，缓释安非他酮用于戒烟的净收益（即收益减去成本）此前已在临床试验中进行评估，这些试验包括频繁的面对面行为咨询以及制造商推荐的剂量，但未在实际应用场景和较低剂量情况下进行评估。
本研究的目的是从雇主的角度确定在实际应用场景中，两种安非他酮缓释剂量方案与最低强度（定制邮件，TM）或中等强度（主动电话，PTC）行为干预相结合的投资回报率（ROI）和内部收益率（IRR）。
在华盛顿州西雅图市的一个大型医疗系统（Group Health Cooperative）中进行了一项为期1年随访的开放标签随机试验。参与者包括1524名有戒烟意愿的成年吸烟者。参与者被随机分配接受每日150毫克安非他酮缓释剂和PTC（n = 382）、每日150毫克安非他酮缓释剂和TM（n = 381）、每日300毫克安非他酮缓释剂和PTC（n = 383）或每日300毫克安非他酮缓释剂和TM（n = 378）。为患者提供了足够8周剂量的药物。现场试验的主要结局指标是12个月时自我报告的7天点患病率非吸烟状态，经济分析的主要结局指标是雇主净收益、雇主ROI以及使用2002年美元计算的与ROI相关的IRR。
使用净收益时，300毫克/ PTC和150毫克/ PTC治疗方案的偏好程度大致相同。使用ROI或IRR时，150毫克/ TM和150毫克/ PTC治疗方案的偏好程度大致相同，IRR值分别为31.7%和31.4%。在关于有效性和成本的悲观情况下，150毫克/ PTC比150毫克/ TM更具成本效益，150毫克/ PTC的雇主IRR为13%。在乐观情况下，所有治疗方案的IRR均超过45%。
这些结果表明，雇主通过赞助戒烟项目可获得具有竞争力的投资回报，150毫克安非他酮剂量比300毫克剂量产生更好的回报，并且如果目标员工群体的戒烟率低于研究人群，PTC治疗应优于TM。
