Maciosek Michael V, LaFrance Amy B, Dehmer Steven P, McGree Dana A, Xu Zack, Flottemesch Thomas J, Solberg Leif I
HealthPartners Institute, Minneapolis, Minnesota
HealthPartners Institute, Minneapolis, Minnesota.
Ann Fam Med. 2017 Jan;15(1):37-47. doi: 10.1370/afm.2022. Epub 2017 Jan 6.
To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation.
We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews.
Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates.
Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.
为帮助临床医生和医疗系统在繁忙的门诊日程中确定烟草咨询的优先级，我们评估了每年对青少年进行劝阻吸烟起始的咨询以及每年对成年人进行鼓励戒烟的咨询在一生的健康和经济价值。
我们进行了微观模拟分析，以估计在美国400万出生队列中这两种烟草咨询的健康影响和成本效益。用于分析的模型是根据具有全国代表性的数据集和结构化文献综述构建的。
与不进行烟草咨询相比，该模型预测，每年对青少年进行咨询将使成年期吸烟的平均患病率降低2.0个百分点，而每年对成年人进行咨询将使患病率降低3.8个百分点。对青少年进行咨询将预防42,686例由吸烟导致的死亡，并在该队列的一生中使质量调整生命年（QALY）增加756,601。对成年人进行咨询将预防69,901例由吸烟导致的死亡，并使QALY增加1,044,392。对青少年和成年人进行咨询每人将分别产生225美元和580美元的净节省。如果在青少年和成年期都对该队列提供年度烟草咨询，那么与不进行咨询相比，成年吸烟率将低5.5个百分点，并且在他们的一生中由吸烟导致的死亡将减少105,917例。按照当前的咨询率，仅实现了咨询潜在健康和经济效益的三分之一。
简短的烟草咨询在节省成本的同时带来了巨大的健康益处。青少年和成年人干预都是临床医生有限时间的高优先级用途。
