University of Ottawa Heart Institute, Ottawa, ON, Canada.
University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON, Canada.
Br J Cancer. 2024 Oct;131(7):1178-1185. doi: 10.1038/s41416-024-02819-z. Epub 2024 Aug 14.
We examined the cost-effectiveness of providing systematic smoking cessation interventions to oncology patients at point-of-care.
A decision analytic model was completed from the healthcare payer's perspective and included all incident cancer cases involving patients who smoke in New Brunswick, Canada (n = 1040), cancer site stratifications, and risks of mortality, continued smoking, and cancer treatment failure over one year. Usual care (no cessation support) was compared to the standard Ottawa Model for Smoking Cessation (OMSC) intervention, and to OMSC plus unlimited cost-free stop smoking medication (OMSC + SSM), including nicotine replacement therapy, varenicline, or bupropion. Primary outcomes were incremental cost per quit (ICQ) and incremental cost per cancer treatment failure avoided (ICTFA).
The ICQ was $C143 and ICTFA $C1193 for standard OMSC. The ICQ was $C503 and ICTFA was $C5952 for OMSC + SSM. The number needed to treat (NNT) to produce one quit was 9 for standard OMSC and 4 for OMSC + SSM, and the NNT to avoid one first-line treatment failure was 78 for OMSC and 45 for OMSC + SSM. Both were cost-effective in 100% of 1000 simulations.
Given the high clinical benefits and low incremental costs, systematic smoking cessation interventions should be a standard component of first-line cancer treatment.
我们研究了在医疗保健点为肿瘤患者提供系统戒烟干预的成本效益。
从医疗保健支付者的角度完成了决策分析模型，包括涉及新不伦瑞克省（加拿大）吸烟的所有癌症患者（n=1040）、癌症部位分层以及一年内死亡率、持续吸烟和癌症治疗失败风险的所有新癌症病例。将常规护理（无戒烟支持）与标准渥太华戒烟模式（OMSC）干预进行比较，并与 OMSC 加无限量免费戒烟药物（OMSC+SSM）进行比较，包括尼古丁替代疗法、伐尼克兰或安非他酮。主要结果是每戒烟增量成本（ICQ）和每避免一次癌症治疗失败的增量成本（ICTFA）。
标准 OMSC 的 ICQ 为$C143，ICTFA 为$C1193。OMSC+SSM 的 ICQ 为$C503，ICTFA 为$C5952。标准 OMSC 的每治疗一例需要治疗的人数（NNT）为 9，而 OMSC+SSM 的 NNT 为 4，避免一线治疗失败的 NNT 为 78，而 OMSC+SSM 的 NNT 为 45。在 1000 次模拟的 100%中，两者均具有成本效益。
鉴于高临床效益和低增量成本，系统的戒烟干预应该成为一线癌症治疗的标准组成部分。
