The University of Queensland, School of Population Health, Herston, QLD 4006, Australia.
Addiction. 2012 Mar;107(3):658-70. doi: 10.1111/j.1360-0443.2011.03632.x. Epub 2011 Nov 1.
To examine the cost-effectiveness of personal smoking cessation support in Vietnam.
DESIGN, SETTING AND PARTICIPANTS: We followed-up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost-effective. A multi-state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health-care perspective was employed.
Cost-effectiveness is measured in 2006 Vietnamese Dong (VND) per disability-adjusted life year (DALY) averted. We adopted the World Health Organization thresholds of being 'cost-effective' if less than three times gross domestic product (GDP) per capita (VND 34,600,000) and 'very cost-effective' if less than GDP per capita (VND 11,500,000).
The cost-effectiveness result of physician brief advice was VND 1,742,000 per DALY averted (international dollars 543), which was 'very cost-effective'. Varenicline dominated bupropion and nicotine-replacement therapies, although it did not fall within the range of being 'cost-effective' under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost-effective in Vietnam.
Physician brief advice is a cost-effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost-effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.
考察越南为个人提供戒烟支持的成本效益。
设计、设置和参与者：我们对 2006 年年龄在 15 岁及以上的人群进行了随访，以对以下 5 种干预措施的成本和健康收益进行建模：医生简短建议、尼古丁替代疗法（贴片和口香糖）、安非他酮和伐尼克兰。采用阈值分析来确定药物干预的价格水平，以使药物干预具有成本效益。构建了一个多状态生命表模型，使干预措施影响年龄队列的戒烟行为，由此产生的吸烟率定义了他们的健康结果。采用了卫生保健视角。
成本效益以每避免一个残疾调整生命年（DALY）的 2006 年越南盾（VND）来衡量。我们采用了世界卫生组织的标准，如果成本效益低于人均国内生产总值（GDP）的三倍（VND 3460 万），则认为是“具有成本效益”；如果低于人均 GDP（VND 1150 万），则认为是“非常具有成本效益”。
医生简短建议的成本效益结果为每避免一个 DALY 的成本为 1742 万越南盾（国际美元 543），被认为是“非常具有成本效益”。伐尼克兰优于安非他酮和尼古丁替代疗法，尽管在不同情况下，它并未处于具有成本效益的范围内。阈值分析表明，如果要使药物治疗在越南具有成本效益，那么药物的价格必须大大低于其他国家的水平。
医生简短建议是一种具有成本效益的干预措施，应被列入越南烟草控制政策的优先清单。在越南，药物治疗目前不具有成本效益，因此不建议使用，除非未来能够以更低的成本在当地生产药品。
