Mattock Richard, Owen Lesley, Taylor Matthew
Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
York Health Economics Consortium, University of York, York, UK.
EClinicalMedicine. 2023 Feb 1;57:101828. doi: 10.1016/j.eclinm.2023.101828. eCollection 2023 Mar.
Tailored smoking cessation interventions, which combine behavioural and pharmaceutical support, are effective in populations with severe mental illness (SMI). We establish the cost-effectiveness of two tailored interventions in the UK: (i) a bespoke smoking cessation intervention (BSCI) versus usual care, and (ii) integrated tobacco cessation and mental health care (IC) versus standard smoking cessation clinic (SCC) referral.
This economic evaluation was conducted between January 15th 2019 and August 4th 2022. We adapted a Markov model estimating smoking status, healthcare costs and quality-adjusted life years (QALYs) across the lifetime. Intervention effectiveness and costs were obtained from a systematic review and a meta-analysis. We obtained specific parameter values for populations with SMI for mortality, risk of smoking related comorbidities, and health utility. Uncertainty was analysed in deterministic and probabilistic sensitivity analysis (PSA).
The BSCI was cost-effective versus usual care with an incremental cost-effectiveness ratio (ICER) of £3145 per QALY (incremental costs: £165; incremental QALYs: 0.05). Integrated care was cost-effective versus SCC with an ICER of £6875 per QALY (incremental costs: £292; incremental QALYs: 0.04). The BSCI and IC were cost-effective in 89% and 83% of PSA iterations respectively. The main area of uncertainty related to relapse rates.
Our findings suggested that the tailored interventions were cost-effective and could increase QALYs and decrease expenditure on treating smoking related morbidities if offered to people with SMI.
York Health Economics Consortium was funded by the National Institute for Health and Care Excellence to produce economic evaluations to inform public health guidelines.
量身定制的戒烟干预措施，即结合行为和药物支持，对患有严重精神疾病（SMI）的人群有效。我们在英国确定了两种量身定制干预措施的成本效益：（i）定制戒烟干预（BSCI）与常规护理对比，以及（ii）综合戒烟与心理健康护理（IC）与标准戒烟诊所（SCC）转诊对比。
这项经济评估于2019年1月15日至2022年8月4日进行。我们采用了一个马尔可夫模型来估计一生中的吸烟状况、医疗成本和质量调整生命年（QALYs）。干预效果和成本来自系统评价和荟萃分析。我们获得了患有SMI人群在死亡率、吸烟相关合并症风险和健康效用方面的特定参数值。在确定性和概率敏感性分析（PSA）中分析了不确定性。
与常规护理相比，BSCI具有成本效益，增量成本效益比（ICER）为每QALY 3145英镑（增量成本：165英镑；增量QALYs：0.05）。与SCC相比，综合护理具有成本效益，ICER为每QALY 6875英镑（增量成本：292英镑；增量QALYs：0.04）。在PSA迭代中，BSCI和IC分别在89%和83%的情况下具有成本效益。主要的不确定性领域与复发率有关。
我们的研究结果表明，量身定制的干预措施具有成本效益，如果提供给患有SMI的人群，可以增加QALYs并减少治疗吸烟相关疾病的支出。
约克健康经济联盟由国家卫生与保健卓越研究所资助，以进行经济评估，为公共卫生指南提供信息。
