Department of Public Health, University of Otago, Wellington, New Zealand.
Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
BMC Public Health. 2019 Mar 8;19(1):283. doi: 10.1186/s12889-019-6605-8.
Smartphones are increasingly available and some high quality apps are available for smoking cessation. However, the cost-effectiveness of promoting such apps has never been studied. We therefore aimed to estimate the health gain, inequality impacts and cost-utility from a five-year promotion campaign of a smoking cessation smartphone app compared to business-as-usual (no app use for quitting).
A well-established Markov macro-simulation model utilising a multi-state life-table was adapted to the intervention (lifetime horizon, 3% discount rate). The setting was the New Zealand (NZ) population (N = 4.4 million). The intervention effect size was from a multi-country randomised trial: relative risk for quitting at 6 months = 2.23 (95%CI: 1.08 to 4.77), albeit subsequently adjusted to consider long-term relapse. Intervention costs were based on NZ mass media promotion data and the NZ cost of attracting a smoker to smoking cessation services (NZ$64 per person).
The five-year intervention was estimated to generate 6760 QALYs (95%UI: 5420 to 8420) over the remaining lifetime of the population. For Māori (Indigenous population) there was 2.8 times the per capita age-standardised QALY gain relative to non-Māori. The intervention was also estimated to be cost-saving to the health system (saving NZ$115 million [m], 95%UI: 72.5m to 171m; US$81.8m). The cost-saving aspect of the intervention was maintained in scenario and sensitivity analyses where the discount rate was doubled to 6%, the effect size halved, and the intervention run for just 1 year.
This study provides modelling-level evidence that mass-media promotion of a smartphone app for smoking cessation could generate health gain, reduce ethnic inequalities in health and save health system costs. Nevertheless, there are other tobacco control measures which generate considerably larger health gains and cost-savings such as raising tobacco taxes.
智能手机的应用越来越广泛，一些高质量的应用程序可用于戒烟。然而，促进这类应用程序的成本效益从未被研究过。因此，我们旨在估计与常规做法（不使用应用程序戒烟）相比，对戒烟智能手机应用程序进行为期五年的推广活动所带来的健康收益、不平等影响和成本效益。
利用多状态生命表，对一个经过验证的马尔可夫宏观模拟模型进行了调整，以适应干预措施（终生）。该模型的设定是新西兰（NZ）人口（N=440 万）。干预效果大小来自于一项多国家随机试验：6 个月时戒烟的相对风险为 2.23（95%置信区间：1.08 至 4.77），但随后进行了调整，以考虑长期复发的因素。干预成本基于新西兰大众媒体推广数据以及吸引吸烟者戒烟服务的成本（每人 64 新西兰元）。
预计该干预措施在未来五年内将为人口的剩余寿命带来 6760 个 QALY（95%置信区间：5420 至 8420）。与非毛利人相比，毛利人（土著人口）的人均年龄标准化 QALY 增益高出 2.8 倍。该干预措施还被估计为卫生系统节省成本（节省 1.15 亿新西兰元[ m ]，95%置信区间：7250 万至 1.71 亿；8180 万美元）。在情景和敏感性分析中，当贴现率提高到 6%、效果大小减半以及仅开展一年干预措施的情况下，干预措施的节省成本方面仍然得到了维持。
本研究提供了模型层面的证据，表明对戒烟智能手机应用程序进行大众媒体推广可以带来健康收益，减少健康方面的种族不平等，并节省卫生系统的成本。然而，还有其他烟草控制措施可以带来更大的健康收益和成本节约，例如提高烟草税。
