Meenan R T, Stevens V J, Hornbrook M C, La Chance P A, Glasgow R E, Hollis J F, Lichtenstein E, Vogt T M
Kaiser Permanente Center for Health Research, Portland, Oregon 97227-1098, USA.
Med Care. 1998 May;36(5):670-8. doi: 10.1097/00005650-199805000-00007.
This study evaluated the cost-effectiveness of a smoking cessation and relapse-prevention program for hospitalized adult smokers from the perspective of an implementing hospital. It is an economic analysis of a two-group, controlled clinical trial in two acute care hospitals owned by a large group-model health maintenance organization. The intervention included a 20-minute bedside counseling session with an experienced health counselor, a 12-minute video, self-help materials, and one or two follow-up calls.
Outcome measures were incremental cost (above usual care) per quit attributable to the intervention and incremental cost per discounted life-year saved attributable to the intervention.
Cost of the research intervention was $159 per smoker, and incremental cost per incremental quit was $3,697. Incremental cost per incremental discounted life-year saved ranged between $1,691 and $7,444, much less than most other routine medical procedures. Replication scenarios suggest that, with realistic implementation assumptions, total intervention costs would decline significantly and incremental cost per incremental discounted life-year saved would be reduced by more than 90%, to approximately $380.
Providing brief smoking cessation advice to hospitalized smokers is relatively inexpensive, cost-effective, and should become a part of the standard of inpatient care.
本研究从实施医院的角度评估了一项针对住院成年吸烟者的戒烟及预防复吸项目的成本效益。这是一项对由大型集团模式健康维护组织所有的两家急症护理医院进行的两组对照临床试验的经济分析。干预措施包括与经验丰富的健康顾问进行20分钟的床边咨询、观看12分钟的视频、提供自助材料以及进行一到两次随访电话。
结果指标为干预措施导致的每例戒烟的增量成本（高于常规护理）以及干预措施导致的每挽救一个贴现生命年的增量成本。
研究干预措施的成本为每位吸烟者159美元，每增加一例戒烟的增量成本为3697美元。每增加一个贴现生命年挽救的增量成本在1691美元至7444美元之间，远低于大多数其他常规医疗程序。重复分析表明，在现实的实施假设下，干预总成本将显著下降，每增加一个贴现生命年挽救的增量成本将降低90%以上，降至约380美元。
为住院吸烟者提供简短的戒烟建议相对便宜、具有成本效益，应成为住院护理标准的一部分。
