Fiscella K, Franks P
Primary Care Institute, Highland Hospital, Rochester, NY, USA.
JAMA. 1996 Apr 24;275(16):1247-51.
To determine the incremental cost-effectiveness of the transdermal nicotine patch.
Decision analytic model that evaluated the incremental cost-effectiveness of the addition of the nicotine patch to smoking cessation counseling. Costs were based on physician time and the retail cost of the nicotine patch, and benefits were based on quality-adjusted life years (QALYs) saved.
Male and female smokers aged 25 to 69 years receiving primary care.
Addition of the nicotine patch to physician-based smoking cessation counseling.
Costs (1995 dollars) per QALYs save discounted by 3% annually.
The use of the patch produced 1 additional lifetime quitter at a cost of $7332. The incremental cost-effectiveness of the nicotine patch by age group ranged from $4390 to $10 943 per QALY for men and $4955 to $6983 per QALY for women. A clinical strategy involving limiting prescription renewals to patients successfully abstaining for the first 2 weeks improved the cost-effectiveness of the patch by 25%.
The findings provide support both for the routine use of the nicotine patch as an adjunct to physicians' smoking cessation counseling and for health insurance coverage of nicotine patch therapy.
确定经皮尼古丁贴片的增量成本效益。
决策分析模型，评估在戒烟咨询中添加尼古丁贴片的增量成本效益。成本基于医生的时间和尼古丁贴片的零售成本，效益基于节省的质量调整生命年（QALY）。
年龄在25至69岁之间接受初级保健的男性和女性吸烟者。
在基于医生的戒烟咨询中添加尼古丁贴片。
每年按3%贴现的每节省一个QALY的成本（1995年美元）。
使用该贴片每产生1例终身戒烟者的成本为7332美元。尼古丁贴片按年龄组划分的增量成本效益，男性为每QALY 4390至10943美元，女性为每QALY 4955至6983美元。一种临床策略，即限制仅为在前两周成功戒烟的患者续开处方，可使贴片的成本效益提高25%。
研究结果支持将尼古丁贴片作为医生戒烟咨询的辅助手段常规使用，以及支持尼古丁贴片疗法的医疗保险覆盖范围。
