Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada.
Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Québec, Canada.
JAMA Netw Open. 2021 Apr 1;4(4):e213927. doi: 10.1001/jamanetworkopen.2021.3927.
Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known.
To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020.
The trial compared CEASE (practice training and support to address family tobacco use) vs usual care.
The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs.
The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures.
These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.
父母吸烟会对父母和孩子的健康产生不利影响。儿科环境中提供了有效的干预措施来帮助父母戒烟。这种干预措施的成本效益尚不清楚。
从医疗机构的角度评估在儿科初级保健中实施的父母戒烟干预措施（CEASE 项目）的成本效益，与常规护理进行比较。
设计、地点和参与者：本经济学评价使用了作为 CEASE 随机临床试验的一部分前瞻性收集的干预成本和父母戒烟数据。数据于 2015 年 4 月至 2017 年 10 月在 5 个美国州的儿科办公室收集。参与者包括参加 10 个儿科初级保健实践的儿童的父母（5 个对照组，5 个干预组）。数据分析于 2019 年 10 月至 2020 年 8 月进行。
试验比较了 CEASE（针对家庭烟草使用的实践培训和支持）与常规护理。
使用微观成本法计算了 CEASE 干预的总成本和每戒烟的增量成本。使用在重复横截面中评估的 2 个试验结果措施来估计 CEASE 的效果：（1）通过父母报告在计划启动后 2 周（基线）和 2 年随访时评估的吸烟流行率变化干预与常规护理实践之间，（2）在基线和随访时，在过去 2 年内实现可替宁确认戒烟的吸烟者比例的变化。使用蒙特卡罗分析提供了 95%CI。
研究共纳入了 3054 名参与者（基线时 1523 名，随访时 1531 名）；2163 名（70.8%）年龄在 25 至 44 岁之间，2481 名（81.2%）为女性。在 2 年期间，5 个干预实践实施和维持 CEASE 的总成本为 115778 美元。根据父母报告的吸烟流行率变化，CEASE 与常规护理相比，每戒烟的增量成本为 1132 美元（95%CI，653 美元至 3603 美元），根据可替宁确认的戒烟，每戒烟的增量成本为 762 美元（95%CI，418 美元至 2883 美元）。基于父母报告的吸烟流行率，CEASE 在 88.0%的模拟中具有成本效益，基于可替宁确认的戒烟措施，在 94.6%的模拟中具有成本效益，在 2000 美元/戒烟的意愿支付阈值下。
这些发现表明，CEASE 干预措施与其他临床戒烟干预措施相比，每戒烟的增量成本具有优势。CEASE 在儿科临床环境中启动和维持的成本较低，这表明它有可能对人群健康产生重大影响。
