Rasch A, Greiner W
Fakultät für Gesundheitswissenschaften, Gesundheitsökonomie und Gesundheitsmanagement (AG5), Universität Bielefeld.
Gesundheitswesen. 2009 Nov;71(11):732-8. doi: 10.1055/s-0029-1214400. Epub 2009 Jun 2.
Most of German health insurance funds provide and reimburse cognitive-behavioural group-based courses for smoking cessation according to section sign 20 Abs. 1 SGB V or section sign 20 a SGB V. The main goal of this study is to conduct a review of the efficacy and cost-effectiveness of these smoking cessation courses and their methodical approaches.
A literature search for available systematic reviews, meta-analyses, health technology assessments (HTA), and guidelines was conducted in relevant databases.
Overall, six publications were included. Two sources confirm the long-term efficacy of group-based smoking cessation approach [OR (odds ratio)=1.3 and OR=2.17] with meta-analyses. The majority of available reviews or national guidelines are based on the results of these two researches. Two further reviews estimate the behaviour-based group therapy as effective. The efficacy estimation of single behavioural intervention components (skill training, problem solv-ing, relapse prevention) varies from OR=0.91 to OR=1.5. The evidence is insufficient for the internationally widespread course "Allen Carr's Easyway". No relevant publications on economic issues could be included for the courses currently made available by the statutory health insurance.
The methodical approaches of smoking cessation courses offered by health insurance funds are effective and recommendable according to the available secondary literature. The efficacy of these interventions is not very high and solely covers general methodical approaches or programme components. Evaluations of current smoking cessation courses are rare and do not meet internationally accepted standards. Further research should be aimed to evaluate the established programmes with high-quality health economic studies.
根据德国社会法典第五编第20条第1款或第20a条，大多数德国健康保险基金提供并报销基于认知行为的戒烟团体课程。本研究的主要目的是对这些戒烟课程的疗效、成本效益及其方法进行综述。
在相关数据库中检索现有的系统评价、荟萃分析、卫生技术评估（HTA）和指南。
总共纳入了六篇文献。两项研究通过荟萃分析证实了基于团体的戒烟方法的长期疗效[比值比（OR）=1.3和OR=2.17]。大多数现有综述或国家指南均基于这两项研究的结果。另外两项综述估计基于行为的团体治疗是有效的。对单个行为干预成分（技能培训、问题解决、预防复吸）的疗效估计值在OR=0.91至OR=1.5之间。对于国际上广泛开展的“艾伦·卡尔轻松戒烟法”课程，证据不足。对于法定健康保险目前提供的课程，未纳入有关经济问题的相关文献。
根据现有二手文献，健康保险基金提供的戒烟课程方法是有效的且值得推荐。这些干预措施的疗效不是很高，仅涵盖一般的方法或项目组成部分。对当前戒烟课程的评估很少，且不符合国际公认的标准。未来的研究应以高质量的卫生经济学研究评估现有项目为目标。
