Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Herston Q4029, Australia.
Cost Eff Resour Alloc. 2010 Sep 16;8:18. doi: 10.1186/1478-7547-8-18.
Many smoking-cessation programs and pharmaceutical aids demonstrate substantial health gains for a relatively low allocation of resources. Genetic information represents a type of individualized or personal feedback regarding the risk of developing lung cancer, and hence the potential benefits from stopping smoking, may motivate the person to remain smoke-free. The purpose of this study was to explore what the impact of a genetic test needs to have within a typical smoking-cessation program aimed at heavy smokers in order to be cost-effective.
Two strategies were modelled for a hypothetical cohort of heavy smokers aged 50 years; individuals either received or did not receive a genetic test within the course of a usual smoking-cessation intervention comprising nicotine replacement therapy (NRT) and counselling. A Markov model was constructed using evidence from published randomized controlled trials and meta-analyses for estimates on 12-month quit rates and long-term relapse rates. Epidemiological data were used for estimates on lung cancer risk stratified by time since quitting and smoking patterns. Extensive sensitivity analyses were used to explore parameter uncertainty.
The discounted incremental cost per QALY was AU$34,687 (95% CI $12,483, $87,734) over 35 years. At a willingness-to-pay of AU$20,000 per QALY gained, the genetic testing strategy needs to produce a 12-month quit rate of at least 12.4% or a relapse rate 12% lower than NRT and counselling alone for it to be equally cost-effective. The likelihood that adding a genetic test to the usual smoking-cessation intervention is cost-effective was 20.6% however cost-effectiveness ratios were favourable in certain situations (e.g., applied to men only, a 60 year old cohort).
The findings were sensitive to small changes in critical variables such as the 12-month quit rates and relapse rates. As such, the cost-effectiveness of the genetic testing smoking cessation program is uncertain. Further clinical research on smoking-cessation quit and relapse rates following genetic testing is needed to inform its cost-effectiveness.
许多戒烟计划和药物辅助手段在投入相对较少资源的情况下，就能显著改善健康状况。遗传信息是一种关于罹患肺癌风险的个体化或个人反馈，因此，停止吸烟的潜在益处可能会促使人们保持不吸烟状态。本研究旨在探讨在针对重度吸烟者的典型戒烟计划中，基因检测需要产生何种影响，才能具有成本效益。
针对年龄在 50 岁的重度吸烟者假设队列，对两种策略进行了建模；在包括尼古丁替代疗法（NRT）和咨询在内的常规戒烟干预过程中，个体要么接受基因检测，要么不接受基因检测。使用来自已发表的随机对照试验和荟萃分析的证据，构建了一个马尔可夫模型，以估计 12 个月的戒烟率和长期复发率。使用流行病学数据对按戒烟时间和吸烟模式分层的肺癌风险进行估计。进行了广泛的敏感性分析以探索参数不确定性。
在 35 年内，每增加一个质量调整生命年（QALY）的增量成本为 34687 澳元（95%置信区间为 12483 澳元至 87734 澳元）。在愿意支付每获得一个 QALY 20000 澳元的情况下，基因检测策略需要产生至少 12.4%的 12 个月戒烟率，或者比 NRT 和咨询单独使用时的复发率低 12%，才能具有成本效益。然而，将基因检测添加到常规戒烟干预措施中具有成本效益的可能性为 20.6%，但在某些情况下（例如，仅适用于男性，60 岁的队列），成本效益比是有利的。
研究结果对关键变量的微小变化（例如 12 个月的戒烟率和复发率）很敏感。因此，基因检测戒烟计划的成本效益尚不确定。需要进一步开展关于基因检测后戒烟和复发率的临床研究，为其成本效益提供信息。
