社区药房戒烟干预：12 个月随访的非随机群组对照试验的成本效益。

Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months' follow-up.

机构信息

Respiratory and Smoking Group of the Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain; Spanish Society of Clinical, Family and Community Pharmacy, Paseo de las Delicias 31, Madrid, Spain.

出版信息

Res Social Adm Pharm. 2024 Jan;20(1):19-27. doi: 10.1016/j.sapharm.2023.09.003. Epub 2023 Sep 7.

DOI:10.1016/j.sapharm.2023.09.003

PMID:37704533

Abstract

BACKGROUND

This study evaluated the cost-effectiveness of an intervention based on a training course for community pharmacists and a smoking cessation service (CESAR©), using limited societal and the health provider perspectives.

METHODS

Non-randomized controlled trial of 12-months' follow-up. Spanish community pharmacists who were previously trained with CESAR© formed the intervention group (n = 102), and control group delivered usual care (n = 80). CESAR Patients were smokers identified by the community pharmacists when they attended the pharmacy. Data were self-reported. Outcomes were smoking cessation and quality-of-life (EQ-5D-3L) and were collected at baseline, 6, and 12 months. Costs data included direct health costs, work loss, and intervention costs. Smoking cessation was analyzed through logistic regression models. Generalized linear models were carried out for quality-adjusted life year (QALY) and costs. Incremental cost-effectiveness ratio (ICER) and cost-utility ratio (ICUR) were calculated.

RESULTS

In total, 800 smoking patients were included in the intervention group and 278 in the control group. Of these, 487 and 151 patients completed the study, respectively. Costs were lower in the intervention group compared to the control group in both perspectives. At 12 months, 54.3% and 37.1% patients from the intervention and the control groups reported smoking cessation, respectively. The difference in probability of cessation in the intervention compared to the control group was 17.6% (CI:0.05; 0.25). The mean QALY was higher in the intervention group [0.03(CI: 0.01; 0.07)]. The ICER and the ICUR were dominant for the intervention group.

CONCLUSION

This intervention for smoking cessation showed that the CESAR© intervention, that combined a training for community pharmacists with a smoking cessation service was efficient for smoking cessation and QALY at 12 months' follow-up.

TRIAL REGISTRATION

NCT05461066, retrospectively registered (July 15, 2022).

摘要

背景

本研究从有限的社会和医疗服务提供者角度评估了一项基于社区药剂师培训课程和戒烟服务（CESAR©）的干预措施的成本效益。

方法

这是一项为期 12 个月随访的非随机对照试验。接受过 CESAR©培训的西班牙社区药剂师组成干预组（n=102），对照组提供常规护理（n=80）。CESAR 患者是社区药剂师在药房就诊时发现的吸烟者。数据采用自我报告的方式收集。结果为戒烟和生活质量（EQ-5D-3L），分别在基线、6 个月和 12 个月时进行评估。成本数据包括直接医疗成本、工作损失和干预成本。通过逻辑回归模型分析戒烟情况。采用广义线性模型进行质量调整生命年（QALY）和成本分析。计算增量成本效益比（ICER）和成本效用比（ICUR）。

结果

共有 800 名吸烟患者纳入干预组，278 名患者纳入对照组。其中，分别有 487 名和 151 名患者完成了研究。从两个角度来看，干预组的成本均低于对照组。在 12 个月时，干预组和对照组分别有 54.3%和 37.1%的患者报告戒烟。干预组与对照组相比，戒烟的概率差异为 17.6%（CI：0.05；0.25）。干预组的平均 QALY 更高[0.03（CI：0.01；0.07）]。干预组的 ICER 和 ICUR 占主导地位。