Krumholz H M, Cohen B J, Tsevat J, Pasternak R C, Weinstein M C
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510.
J Am Coll Cardiol. 1993 Nov 15;22(6):1697-702. doi: 10.1016/0735-1097(93)90598-u.
The purpose of this study was to evaluate the cost-effectiveness of a smoking cessation program initiated after acute myocardial infarction.
The value of allocating health care resources to smoking cessation programs after myocardial infarction has not been compared with the value of other currently accepted interventions.
A model was developed to examine the cost-effectiveness of a recently reported smoking cessation program after an acute myocardial infarction. The cost was estimated by considering the resources necessary to implement the program, and the effectiveness was expressed as discounted years of life saved. Years of life saved were estimated by modeling life expectancy using a single declining exponential approximation of life expectancy based on data from published reports.
The cost-effectiveness of the nurse-managed smoking cessation program was estimated to be $220/year of life saved. In a one-way sensitivity analysis, the cost-effectiveness of the program remained < $20,000/year of life saved if the program decreased the smoking rate by only 3/1,000 smokers (baseline assumption 26/100 smokers), or if the program cost as much as $8,840/smoker (baseline assumption $100). In a two-way sensitivity analysis, even if the cost of the program were as high as $2,000/participant, the cost-effectiveness of the program would be < $10,000/year of life saved so long as the program helped an additional 12 smokers quit for every 100 enrolled.
Over a wide range of estimates of costs and effectiveness, a nurse-managed smoking cessation program after acute myocardial infarction is an extremely cost-effective intervention. This program is more cost-effective than beta-adrenergic antagonist therapy after myocardial infarction.
本研究旨在评估急性心肌梗死后启动的戒烟计划的成本效益。
将医疗保健资源分配到心肌梗死后的戒烟计划的价值尚未与其他目前被接受的干预措施的价值进行比较。
开发了一个模型来检验急性心肌梗死后最近报道的戒烟计划的成本效益。通过考虑实施该计划所需的资源来估计成本，有效性以贴现的挽救生命年数表示。根据已发表报告的数据，使用预期寿命的单一递减指数近似值对预期寿命进行建模，从而估计挽救的生命年数。
护士管理的戒烟计划的成本效益估计为每挽救一年生命220美元。在单向敏感性分析中，如果该计划仅使吸烟率每1000名吸烟者降低3人（基线假设为每100名吸烟者中有26人），或者如果该计划每位吸烟者的成本高达8840美元（基线假设为100美元），该计划的成本效益仍低于每挽救一年生命20000美元。在双向敏感性分析中，即使该计划的成本高达每位参与者2000美元，只要该计划每招募100人能帮助另外12名吸烟者戒烟，该计划的成本效益就会低于每挽救一年生命10000美元。
在广泛的成本和有效性估计范围内，急性心肌梗死后由护士管理的戒烟计划是一种极具成本效益的干预措施。该计划比心肌梗死后的β-肾上腺素能拮抗剂治疗更具成本效益。
