Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA; Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA.
Am J Surg. 2018 Dec;216(6):1082-1089. doi: 10.1016/j.amjsurg.2018.08.010. Epub 2018 Aug 29.
Smoking is a known risk factor for postoperative complications after colectomy. Using the perspective of the provider, this study evaluated the cost-effectiveness of the pharmacologic interventions for smoking cessation.
A decision tree model was constructed to represent a provider's decision to provide either bupropion, nicotine replacement therapy, varenicline, or no cessation therapy to all patients presenting for elective colectomy. Incremental cost per quality-adjusted life year (QALY) was the primary outcome.
The base case analysis suggests that bupropion is cost-effective with an incremental cost-effectiveness ratio of approximately $75,000 per QALY. Sensitivity analyses established ranges for which each medication might be cost-effective and dominant compared to offering no cessation therapy.
From a provider perspective, offering bupropion for smoking cessation to patients scheduled for elective colon resection is cost-effective. Furthermore, these results provide benchmarks to inform providers about whether targeted, short-term smoking cessation therapies represent good value in colectomies.
吸烟是结肠切除术后术后并发症的已知危险因素。从提供者的角度来看，本研究评估了药物干预戒烟的成本效益。
构建了一个决策树模型，以代表提供者为所有接受择期结肠切除术的患者提供安非他酮、尼古丁替代疗法、伐尼克兰或不进行戒烟治疗的决策。增量成本每质量调整生命年（QALY）是主要结果。
基础案例分析表明，安非他酮具有成本效益，增量成本效益比约为每 QALY 75,000 美元。敏感性分析确定了每种药物在与不提供戒烟治疗相比可能具有成本效益和优势的范围。
从提供者的角度来看，为计划接受择期结肠切除术的患者提供安非他酮戒烟是具有成本效益的。此外，这些结果为提供者提供了基准，以了解针对短期戒烟治疗在结肠切除术中是否具有良好的价值。
