University of Minnesota School of Public Health, Minneapolis, MN, USA.
VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis, MN, USA.
Addiction. 2019 Dec;114(12):2206-2216. doi: 10.1111/add.14752. Epub 2019 Sep 4.
To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid).
Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial.
The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective.
Data were used from 2406 smokers who were randomized into the intervention or comparator groups.
The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline.
Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year.
The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time.
Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.
评估 OPT-IN 主动戒烟外展计划在参加低收入人群公共资助健康保险计划（如医疗补助）的成年吸烟者中的人群成本效益。
使用基于 Offering Proactive Treatment Intervention（OPT-IN）随机对照试验数据的状态转换模型进行成本效益分析。
该试验在美国明尼苏达州进行，经济分析从医疗补助计划的角度进行。
数据来自 2406 名被随机分配到干预组或对照组的吸烟者。
干预措施包括主动外展（邮寄邀请和电话）和免费戒烟治疗（尼古丁替代疗法和强化电话咨询）。对照组为常规护理，包括获得初级保健医生、保险覆盖食品和药物管理局（FDA）批准的戒烟药物和该州的电话戒烟热线。
不同时间点的吸烟状况、生活质量和医疗保健使用情况，包括基线和 1 年。
OPT-IN 计划比对照组平均每位参与者多花费 84 美元。随机分组后 1 年，主动外展干预组的人群 6 个月延长吸烟戒断率为 16.5%，常规护理组为 12.1%（P<0.05）。模型预测，主动外展干预增加了终生成本 78 美元，并产生了 0.005 个额外的质量调整生命年（QALY），预期增量成本效益比为每 QALY4231 美元。概率敏感性分析发现，主动外展干预在约 68%的时间内，相对于 50000 美元/QALY 的意愿支付阈值是具有成本效益的。
与常规护理（即反应性治疗）相比，针对个人电话外展的人群水平主动烟草治疗在实现更高的人群戒烟率方面是有效的，并且在各种意愿支付阈值下具有成本效益。结合先前的研究，人群水平的主动戒烟外展计划被认为是长期内非常具有成本效益的。
