Berndt Nadine, Bolman Catherine, Lechner Lilian, Max Wendy, Mudde Aart, de Vries Hein, Evers Silvia
Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands.
Cellule d'expertise médicale, Inspection générale de la sécurité sociale, Le Gouvernement du Grand-Duché de Luxembourg, POB 1308, 1013, Luxembourg, Luxembourg.
Eur J Health Econ. 2016 Apr;17(3):269-85. doi: 10.1007/s10198-015-0677-x. Epub 2015 Mar 22.
This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective.
In a randomized controlled trial conducted in Dutch hospital wards, cardiac patients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis.
Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust.
Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.
本研究从社会角度考察了两种戒烟咨询干预措施对于确诊为冠心病患者的成本效益和成本效用，这两种干预措施在方式上有所不同。
在荷兰医院病房进行的一项随机对照试验中，入院前吸烟的心脏病患者被分配至常规护理组（n = 245）、电话咨询组（n = 223）或面对面咨询组（n = 157）。咨询干预持续3个月，并辅以尼古丁贴片。获取了基线病史，并在住院6个月后进行访谈，以评估自我报告的吸烟状况和质量调整生命年（QALY）。计算了每位戒烟者的增量成本效益比和每QALY的成本效用比，并以可接受性曲线呈现。通过敏感性分析考虑了不确定性。
以持续戒烟作为结果指标显示，电话咨询具有最高的成本效益可能性。面对面咨询也比常规护理更具成本效益。在三种情况下，未发现QALY有显著改善和差异。不同的成本和效果估计表明，主要分析结果是稳健的。
假设每位戒烟患者的支付意愿为20,000欧元，电话咨询将是一种极具成本效益的戒烟干预措施，可帮助心脏病患者戒烟。然而，关于每位戒烟者支付意愿缺乏共识阻碍了得出确凿结论。此外，需要进行更长随访期的研究来捕捉晚期复发情况以及QALY可能存在的差异。
