Li Jinshuo, Wu Qi, Parrott Steve, Pope Ian, Clark Lucy V, Clark Allan, Ward Emma, Belderson Pippa, Stirling Susan, Coats Timothy J, Bauld Linda, Holland Richard, Gentry Sarah, Agrawal Sanjay, Bloom Benjamin M, Boyle Adrian, Gray Alasdair, Morris M Geraint, Livingstone-Banks Jonathan, Notley Caitlin
Department of Health Sciences, University of York, York, UK.
Norfolk and Norwich University Hospital, Norwich, UK.
Addiction. 2025 Feb;120(2):368-379. doi: 10.1111/add.16698. Epub 2024 Oct 31.
To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective.
DESIGN, SETTING AND PARTICIPANTS: This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥ 8 parts per million, attending the ED (n = 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS.
Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups.
The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%).
The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.
从英国国家医疗服务体系（NHS）和个人社会服务（PSS）的角度，评估急诊科戒烟试验（COSTED）干预措施相较于向当地戒烟服务机构（SSS）提供指引的成本效益。
设计、设置与参与者：这是一项两组、多中心、务实、个体随机对照试验，在英国城乡地区的六个急诊科进行。纳入年龄≥18岁的成年每日吸烟者（每天至少吸一支烟或等量烟草）但非每日使用电子烟者，一氧化碳读数≥8 ppm，且前来急诊科就诊者（n = 972）。干预措施包括提供电子烟启动套件、简短的戒烟建议以及转介至当地的戒烟服务机构。对照组为一张关于如何获取当地戒烟服务机构信息的卡片。
干预成本包括培训和实施成本。对照成本包括印刷信息卡片的成本。基于参与者报告的数量以及从二手资料中提取的单位成本，估算戒烟和医疗服务的成本。通过EQ-5D-5L得出的质量调整生命年（QALY）来衡量效果。其他结局为戒烟措施。主要结局是增量成本效益比（ICER），通过两组成本差异除以QALY差异来计算。
每位参与者的平均干预成本为48英镑[标准误（SE）= 0英镑]，每位参与者的平均对照成本为0.2英镑（SE = 0英镑）。使用回归估计，干预组的总成本比对照组高31英镑[95%置信区间（CI）= -341英镑至283英镑]，6个月的QALY比对照组高0.004（95% CI = -0.004至0.014）。计算得出的ICER为7750英镑（在20000 - 30000英镑范围内具有成本效益的概率：72.2 - 76.5%）。
根据当前最大可接受阈值的建议，英国急诊科戒烟试验（COSTED）干预措施（提供电子烟启动套件加简短戒烟建议）相较于向当地戒烟服务机构提供指引具有成本效益。
