Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas (Madrid), Spain.
Addictive Behaviour Unit of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.
Eur Psychiatry. 2017 Sep;45:41-49. doi: 10.1016/j.eurpsy.2017.05.027. Epub 2017 Jun 3.
Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD.
The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness.
The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios.
Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation.
吸烟与高医疗资源利用和社会成本相关。患有重度抑郁症（MDD）的患者对尼古丁依赖的易感性较高。伐伦克林、安非他酮和尼古丁替代疗法均适用于戒烟；然而，西班牙国家卫生系统（SNHS）的资金有限。我们建立了一项预算影响分析（BIA）来评估 SNHS 为 MDD 吸烟者提供药物戒烟治疗的资金影响。
BIA 使用西班牙 SNHS 和社会观点比较了当前未资助的情况与资助的情况（伐伦克林、安非他酮、尼古丁替代疗法联合医疗随访和咨询）。BIA 设计是一种混合模型，使用决策树算法（人群规模：患有 MDD 的吸烟者）和马尔可夫链（戒烟尝试），时间范围为 5 年。戒烟药物的疗效来自临床试验，避免的戒烟成本来自对西班牙国家健康调查的分析。结果以增量成本节约表示。方案和单变量敏感性分析测试了模型的稳健性。
与未资助方案相比，资助方案在 5 年内导致戒烟尝试增加了 43478 次，吸烟者减少了 8930 人。资助成本为 2530 万欧元，避免的成本为 2650 万欧元。对西班牙社会而言，5 年内的累计增量成本节约为 120 万欧元。使用替代方案的结果是稳健的。
为 MDD 患者提供戒烟药物是对西班牙具有经济效益的，可以从实施的第三年开始产生净节省。
