Cadier Benjamin, Durand-Zaleski Isabelle, Thomas Daniel, Chevreul Karine
AP-HP URC-Eco Ile-de-France, Paris, France.
Inserm, ECEVE, U1123, Paris, France.
PLoS One. 2016 Feb 24;11(2):e0148750. doi: 10.1371/journal.pone.0148750. eCollection 2016.
In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis.
We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million.
The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.
在法国，每年有超过7万例与吸烟相关的疾病死亡病例，自2005年以来烟草流行率有所上升。提供免费的戒烟治疗将减轻这一负担。我们研究的目的是估计提供免费戒烟治疗的增量成本效益比（ICER），同时考虑到与吸烟相关的三种主要疾病（肺癌、慢性阻塞性肺疾病（COPD）和心血管疾病（CVD））减少所带来的成本抵消。为了衡量这一措施的财务影响，我们还进行了概率预算影响分析。
我们使用马尔可夫状态转换模型进行了成本效益分析，将免费戒烟治疗与法国法定医疗保险提供的现有50欧元覆盖范围进行了比较，同时考虑了15至75岁法国现有吸烟者之间的成本抵消情况。我们的结果以终身视角下每获得一个生命年（LYG）的增量成本效益比（以2009年欧元计）来表示。我们估计了一个基础情景，并进行了蒙特卡洛敏感性分析以考虑不确定性。假设参与率为7.3%，在基础情景下，免费戒烟治疗的ICER值为每LYG 3868欧元。参数变化提供了每LYG从-736欧元到15715欧元的ICER值范围。在99%的情况下，全面覆盖的ICER低于每LYG 11187欧元。概率预算影响分析表明，在五年期内，对于1.25亿至4.21亿欧元的初始戒烟治疗成本，肺癌、COPD和CVD的潜在成本节约范围为1500万至2.15亿欧元。
结果表明，为吸烟者戒烟提供医疗支持具有很高的成本效益，甚至可能带来成本节约。
