Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK.
School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
Addiction. 2018 Jun;113 Suppl 1(Suppl Suppl 1):7-18. doi: 10.1111/add.14001. Epub 2017 Sep 14.
Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision-makers need tools to assess the Return on Investment (ROI)/cost-effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking.
EQUIPTMOD uses a Markov model to estimate life-time costs, quality-adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country-specific rates.
For illustration, over a life-time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease-related health care costs than if the smoker ceased smoking in the next 12 months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued.
EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.
尽管减少吸烟带来了明显的好处，但公共卫生提供者面临着越来越大的压力，需要证明投资于烟草控制措施的合理性。决策者需要工具来评估投资回报率（ROI）/成本效益。EQUIPT 项目将一种 ROI 工具从英国应用于四个欧洲国家（德国、荷兰、西班牙和匈牙利）。ROI 工具的核心经济模型 EQUIPTMOD 旨在评估戒烟干预措施包的效率。本文的目的是描述 EQUIPTMOD 的方法，并确定与持续和停止吸烟相关的关键结果。
EQUIPTMOD 使用马尔可夫模型来估计终生成本、质量调整生命年（QALY）和当前和前吸烟者的生命年。它使用关于吸烟流行率、疾病流行率、死亡率以及吸烟对人口的影响的综合数据，结合与疾病相关的成本和效用影响。为了说明该工具的潜力，根据以下假设，基于五个国家的平均当前吸烟者，估算了他们在未来 12 个月内继续和停止吸烟的成本、QALY 和预期寿命：假设他们在未来 12 个月内继续吸烟，或者在未来 12 个月内戒烟。成本和效果按国家特定的利率贴现。
举例来说，在未来 12 个月内不戒烟会导致英格兰的预期寿命缩短 0.66 年，QALY 减少 1.09 年，与在未来 12 个月内戒烟相比，导致与疾病相关的医疗保健费用增加 4961 英镑。对于所有年龄性别类别，在 12 个月内戒烟的人比继续吸烟的人成本更低，QALY 更高。
EQUIPTMOD 有助于评估戒烟策略的成本效益。所展示的结果表明，在个人和人群层面上，戒烟具有巨大的潜在好处。
