Godfrey Christine, Parrott Steve, Coleman Tim, Pound Elspeth
Department of Health Sciences and Centre for Health Economics, Alcuin College, University of York, York, UK.
Addiction. 2005 Apr;100 Suppl 2:70-83. doi: 10.1111/j.1360-0443.2005.01071.x.
To investigate the cost-effectiveness of English specialist smoking cessation services.
Combination of observational cost and outcome data from English smoking cessation services to calculate cost-effectiveness ratios. Multivariate analysis of factors influencing variation in services' cost-effectiveness.
Fifty-eight of the 92 specialist smoking cessation services in England in 2000/01.
Services' costs were estimated using survey data which described services' configurations, staffing, interventions delivered and development. Information on services' throughput and outcomes (as biochemically validated 4-week smoking cessation rates) were obtained from routine sources. With reference to relevant literature and assumptions about relapse and background cessation rates, 4-week cessation rates were converted first to 1-year rates. One-year cessation rates were adjusted to reflect the likely permanent smoking cessation rate attributable to service intervention and finally attributable life-years gained were calculated. A wide variety of sensitivity analyses was performed to test the robustness of the average cost-effectiveness ratio, calculated by combining the cost and life-year gained estimates, for all services. With additional data on deprivation levels in services' areas, ordinary least-squares regression techniques were used to investigate variations in individual services' costs per client and cost-effectiveness ratios.
Using an up-to-date estimate for health gain accrued by stopping smoking, the average cost per life gained was pound 684 (95% CI 557811), falling to pound 438 when savings in future health-care costs were counted. With the worst case assumptions, the estimate of cost-effectiveness rose to pound 2693 per life-year saved (pound 2293 including future health-care costs) and fell to pound 227 (pound 102) under the most favourable assumptions. Findings are comparable to previous published studies. The regression results suggest that different factors influence cost per client and the net cost per life-year saved, indicating that decision makers should be careful in setting performance targets for these services.
In 2000/01, English smoking cessation services provided cost-effective services operating well below the benchmark of pound 20,000 per quality-adjusted life-year saved (QALY) that is used by the National Institute for Clinical Excellence in the United Kingdom.
调查英国专科戒烟服务的成本效益。
结合英国戒烟服务的观察性成本和结果数据来计算成本效益比。对影响服务成本效益差异的因素进行多变量分析。
2000/01年度英国92家专科戒烟服务机构中的58家。
利用描述服务配置、人员配备、提供的干预措施和发展情况的调查数据估算服务成本。从常规来源获取有关服务吞吐量和结果（如经生化验证的4周戒烟率）的信息。参照相关文献以及关于复吸率和背景戒烟率的假设，首先将4周戒烟率转换为1年戒烟率。对1年戒烟率进行调整，以反映因服务干预可能实现的永久戒烟率，最后计算出可归因的获得生命年数。进行了各种敏感性分析，以检验通过结合成本和获得生命年数估计值计算出的所有服务的平均成本效益比的稳健性。利用服务地区贫困水平的额外数据，采用普通最小二乘法回归技术调查各服务机构每位客户的成本和成本效益比的差异。
采用最新的因戒烟而获得的健康收益估计值，每获得一个生命年的平均成本为684英镑（95%可信区间557 - 811英镑），若将未来医疗成本节省计算在内，则降至438英镑。在最不利的假设下，成本效益估计值升至每挽救一个生命年2693英镑（包括未来医疗成本为2293英镑），在最有利的假设下则降至227英镑（102英镑）。研究结果与之前发表的研究结果相当。回归结果表明，不同因素影响每位客户的成本和每挽救一个生命年的净成本，这表明决策者在为这些服务设定绩效目标时应谨慎。
在2000/01年度，英国的戒烟服务提供了具有成本效益的服务，其运作成本远低于英国国家临床优化研究所使用的每挽救一个质量调整生命年（QALY）20000英镑的基准。
