Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institute of Health Economics and Health Care Management, Neuherberg, Germany.
Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK.
Addiction. 2018 Jun;113 Suppl 1(Suppl Suppl 1):52-64. doi: 10.1111/add.14062. Epub 2017 Dec 15.
To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany.
A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.
Germany.
Cohort of current smoking population (18+ years) in Germany.
Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.
EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment.
The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1.
Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.
评估在德国增加特定戒烟干预措施的覆盖范围的成本、效果和成本效益。
使用基于马尔可夫的状态转移投资回报模型（EQUIPTMOD）评估当前的戒烟干预措施以及两种前瞻性投资方案。采用健康保健视角（扩展到包括自付费用）和终身时间范围。使用概率分析评估预测估计的不确定性。
德国。
德国当前吸烟人群（18 岁及以上）的队列。
干预措施包括基于小组的行为支持、财务激励计划和伐伦克林。对于第一个前瞻性情景，将小组行为支持、财务激励计划和伐伦克林的覆盖范围增加了每年戒烟尝试的 1%（=57915 次戒烟尝试），而第二个前瞻性情景则反映了英国的观察到的水平。
EQUIPTMOD 考虑了覆盖范围、干预成本、戒烟人数、获得的生活质量年数（QALYs）、成本效益和投资回报。
通过降低与吸烟相关的医疗保健成本，财务激励计划（每投资 1 欧元可获得 2.71 欧元的回报）和基于小组的行为支持（每投资 1 欧元可获得 1.63 欧元的回报）的回报最高，而与不干预相比，伐伦克林的回报较低（每投资 1 欧元可获得 1.02 欧元的回报）。在人群层面上，与当前投资相比，第一个前瞻性情景导致获得 15034 个 QALYs 和 2700 万欧元的成本节约。干预效果和覆盖范围对投资回报率估计的不确定性贡献最大。在仅 5000 欧元的假设意愿支付阈值下，第一个前瞻性情景具有成本效益的概率约为 75%。
仅将当前每年戒烟尝试的 1%增加到基于小组的行为支持、财务激励和伐伦克林，就为德国政策制定者提供了一种改善人口健康结果且可能具有成本效益的策略。
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