Cornuz J, Gilbert A, Pinget C, McDonald P, Slama K, Salto E, Paccaud F
Department of Ambulatory and Community Medicine, University Hospital, CH-1011 Lausanne, Switzerland.
Tob Control. 2006 Jun;15(3):152-9. doi: 10.1136/tc.2005.011551.
To estimate the incremental cost-effectiveness of the first-line pharmacotherapies (nicotine gum, patch, spray, inhaler, and bupropion) for smoking cessation across six Western countries-Canada, France, Spain, Switzerland, the United States, and the United Kingdom.
A Markov-chain cohort model to simulate two cohorts of smokers: (1) a reference cohort given brief cessation counselling by a general practitioner (GP); (2) a treatment cohort given counselling plus pharmacotherapy. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications.
Addition of each first-line pharmacotherapy to GP cessation counselling.
Cost per life-year saved associated with pharmacotherapies.
The cost per life-year saved for counselling only ranged from US190 dollars in Spain to 773 dollars in the UK for men, and from 288 dollars in Spain to 1168 dollars in the UK for women. The incremental cost per life-year saved for gum ranged from 2230 dollars for men in Spain to 7643 dollars for women in the US; for patch from 1758 dollars for men in Spain to 5131 dollars for women in the UK; for spray from 1935 dollars for men in Spain to 7969 dollars for women in the US; for inhaler from 3480 dollars for men in Switzerland to 8700 dollars for women in France; and for bupropion from 792 dollars for men in Canada to 2922 dollars for women in the US. In sensitivity analysis, changes in discount rate, treatment effectiveness, and natural quit rate had the strongest influences on cost-effectiveness.
The cost-effectiveness of the pharmacotherapies varied significantly across the six study countries, however, in each case, the results would be considered favourable as compared to other common preventive pharmacotherapies.
评估六种一线药物疗法（尼古丁口香糖、贴片、喷雾、吸入器和安非他酮）在加拿大、法国、西班牙、瑞士、美国和英国这六个西方国家帮助戒烟的增量成本效益。
采用马尔可夫链队列模型模拟两组吸烟者：（1）由全科医生提供简短戒烟咨询的参照组；（2）接受咨询加药物治疗的治疗组。疗效以与药物疗法相关的戒烟优势比表示。成本基于所需额外医生时间及药物零售价。
在全科医生戒烟咨询基础上增加每种一线药物疗法。
与药物疗法相关的每挽救一个生命年的成本。
仅接受咨询时，每挽救一个生命年的成本，男性在西班牙为190美元，在英国为773美元；女性在西班牙为288美元，在英国为1168美元。口香糖每挽救一个生命年的增量成本，男性在西班牙为2230美元，女性在美国为7643美元；贴片男性在西班牙为1758美元，女性在英国为5131美元；喷雾男性在西班牙为1935美元，女性在美国为7969美元；吸入器男性在瑞士为3480美元，女性在法国为8700美元；安非他酮男性在加拿大为792美元，女性在美国为2922美元。敏感性分析中，贴现率、治疗效果和自然戒烟率的变化对成本效益影响最大。
六种研究国家中药物疗法的成本效益差异显著，但在每种情况下，与其他常见预防性药物疗法相比，结果都将被视为有利。
