Kaper Janneke, Wagena Edwin J, van Schayck Constant P, Severens Johan L
Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Pharmacoeconomics. 2006;24(5):453-64. doi: 10.2165/00019053-200624050-00004.
Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement.
To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement.
In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping.
Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made.
Reimbursement for SCT may be cost effective if Dutch society is willing to pay 10,000 euro for an additional quitter or 18,000 euro for a QALY.
应鼓励戒烟，以提高预期寿命并降低与吸烟相关的医疗费用。一项随机试验的结果表明，与不报销相比，报销戒烟治疗（SCT）费用可能会导致SCT的使用增加以及戒烟者数量增加。
为了评估SCT报销是否是一种具有成本效益的干预措施（从荷兰社会角度来看），我们计算了每位戒烟者的增量成本，并将此结果外推至与不报销相比每挽救一个质量调整生命年（QALY）的增量成本。
在报销试验中，采用随机双同意设计将1266名荷兰吸烟者随机分配至干预组或对照组。向干预组提供为期6个月的SCT报销。对照组不提供报销。在报销期结束6个月后确定是否长期戒烟。使用来自美国的数据计算直至80岁时因戒烟获得的QALY。从社会角度确定报销期（2002年5月至11月）内的成本（2002年价值）。效益按每年4%进行贴现。使用非参数自举法估计增量成本效益比的不确定性。
对照组有18名参与者（2.8%）成功戒烟，干预组有35名参与者（5.5%）成功戒烟。每位参与者的成本分别为291欧元和322欧元。如果社会愿意为额外一名成功戒烟12个月者支付1000欧元或10000欧元，那么SCT报销具有成本效益的概率分别为50%或95%。如果社会愿意为一个QALY支付18000欧元，那么SCT报销具有成本效益的概率为95%。然而，从戒烟者外推至QALY的外部有效性尚不确定，并且必须做出若干假设。
如果荷兰社会愿意为额外一名戒烟者支付10000欧元或为一个QALY支付18000欧元，那么SCT报销可能具有成本效益。
