Swan Gary E, Jack Lisa M, Javitz Harold S, McAfee Tim, McClure Jennifer B
Center for Health Sciences, SRI International, Menlo Park, California, USA.
CNS Drugs. 2008;22(3):239-56. doi: 10.2165/00023210-200822030-00004.
To examine heterogeneity in outcome at 12 months following 8 weeks of treatment for smoking cessation with bupropion sustained-release (SR) 150 or 300 mg/day combined with behavioural counselling.
DESIGN, SETTING, PARTICIPANTS: Smokers were recruited from a large healthcare system and then randomized to receive either bupropion SR 150 mg/day (n = 763) or 300 mg/day (n = 761) taken for 8 weeks in combination with either proactive telephone counselling or a tailored mail approach.
A comprehensive set of relevant individual pretreatment and treatment characteristics was included in the analysis. Smoking outcome at 12 months was defined as point-prevalence of any regular self-reported smoking within the 7 days prior to follow-up contact. Classification and regression tree analysis identified subgroups that varied with respect to likelihood of being nonsmokers at 12 months. Seven subgroups were identified among those receiving bupropion SR 150 mg/day (proportion of nonsmokers at 12 months ranged from 13.7% to 43.5%) and eight subgroups among those receiving bupropion SR 300 mg/day (proportion of nonsmokers at 12 months ranged from 9.6% to 51.7%). In the 150-mg/day group, those with the lowest rate reported no previous quit attempt of 1 month or more in duration while those with the highest rate all reported previous quit attempts of 1 month or longer. In the 300 mg/day group, those with the lowest rate had very high levels of dependence while those with the highest rate were more highly educated and smoked at a lower level. Across all subgroups, cost per 12-month quitter ranged from a low of USD302 to a high of USD2,502.
These results indicate the presence of a substantial amount of variation in outcome following treatment with both dosages of bupropion SR, with substantial cost consequences. Variation in outcome could be reduced by providing treatments tailored to subgroups of individuals who are at exceptionally high risk for smoking following a quit attempt.
研究使用150或300毫克/天的缓释安非他酮（SR）联合行为咨询进行8周戒烟治疗后12个月时结局的异质性。
设计、地点、参与者：吸烟者从一个大型医疗系统招募，然后随机分为接受150毫克/天（n = 763）或300毫克/天（n = 761）的缓释安非他酮治疗8周，同时联合主动电话咨询或定制邮件方式。
分析纳入了一系列全面的相关个体治疗前和治疗特征。12个月时的吸烟结局定义为随访接触前7天内任何定期自我报告吸烟的点患病率。分类与回归树分析确定了12个月时成为非吸烟者可能性不同的亚组。在接受150毫克/天缓释安非他酮的人群中确定了7个亚组（12个月时非吸烟者比例从13.7%到43.5%），在接受300毫克/天缓释安非他酮的人群中确定了8个亚组（12个月时非吸烟者比例从9.6%到51.7%）。在150毫克/天组中，比率最低的那些人报告之前没有持续1个月或更长时间的戒烟尝试，而比率最高的那些人都报告之前有持续1个月或更长时间的戒烟尝试。在300毫克/天组中，比率最低的那些人依赖性非常高，而比率最高的那些人受教育程度更高且吸烟量更低。在所有亚组中，每12个月成功戒烟者的成本从低至302美元到高至2502美元不等。
这些结果表明，两种剂量的缓释安非他酮治疗后结局存在大量差异，并产生了巨大的成本后果。通过为戒烟尝试后吸烟风险极高的个体亚组提供量身定制的治疗，可以减少结局的差异。
