Pinget Christophe, Martin Erika, Wasserfallen Jean-Blaise, Humair Jean-Paul, Cornuz Jacques
Health Technology Assessment Unit, Lausanne University Hospital, Switzerland.
Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):451-5. doi: 10.1097/HJR.0b013e32804955a0.
Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention.
We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective.
The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio.
Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.
已证明医生戒烟咨询培训作为提高戒烟成功率的一种手段是有效的。我们评估了一项戒烟咨询培训计划的成本效益比。其有效性先前已在瑞士两家大学门诊诊所进行的一项整群随机对照试验中得到证实，在该试验中，住院医生被随机分配接受吸烟干预培训或对照教育干预。
我们使用马尔可夫模拟模型进行有效性分析。该模型纳入了干预效果、自然戒烟率以及戒烟1年后复吸的终生概率。除了医院服务和门诊成本数据外，我们还使用了先前发表的结果。时间范围为1年，我们选择从第三方支付者的角度进行评估。
吸烟者每次咨询的干预增量成本为2.58美元，男性每挽救一个生命年的成本为25.4美元，女性为35.2美元。单向敏感性分析得出男性的成本范围为4.0 - 107.1美元，女性为9.7 - 148.6美元。对照干预的戒烟率、培训效果持续时间和贴现率的变化对结果产生了中等程度的较大影响。自然戒烟率、复吸的终生概率、医生培训成本、咨询时间、医生每小时成本以及手册成本的变化对成本效益比影响很小。
培训住院医生进行戒烟咨询是一种非常具有成本效益的干预措施，可能比目前公认的烟草控制干预措施更有效。
