Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care.
Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care.
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DOI：
10.1001/jamanetworkopen.2021.3927
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Levy DE
中科院分区：
文献类型：
--
作者：
Drouin O;Sato R;Drehmer JE;Nabi-Burza E;Hipple Walters B;Winickoff JP;Levy DE
针对二手烟暴露的临床努力（CEASE）干预是否是儿科实践中帮助父母戒烟的一种具有成本效益的方法？在这项经济学评价中，将CEASE干预纳入儿科初级保健实践中，每次戒烟的增量成本效益比为1132美元。在基于父母报告的吸烟率变化的模拟中，在每次戒烟2000美元的支付意愿阈值下，CEASE具有成本效益。这些研究结果表明，在临床环境中，CEASE的每次戒烟成本优于其他戒烟干预措施。本经济评价从卫生保健组织的角度，与常规护理相比，研究了在儿科初级保健中提供父母戒烟干预的成本效益。父母吸烟对父母和子女的健康都有不利影响。在儿科环境中提供有效的干预措施来帮助父母戒烟。这类干预措施的成本效益尚不清楚。为了评估父母戒烟干预的成本效益，临床努力防止二手烟暴露（CEASE）计划，在儿科初级保健中提供，从卫生保健组织的角度与常规护理相比。这项经济学评估使用了作为CEASE随机临床试验的一部分前瞻性收集的干预费用和父母戒烟的数据。从2015年4月至2017年10月在美国5个州的儿科办公室收集数据。参与者包括参加10个儿科初级保健实践的儿童的父母（5个对照，5个干预）。数据分析于二零一九年十月至二零二零年八月进行。该试验比较了CEASE（解决家庭烟草使用的实践培训和支持）与常规护理。使用微成本法计算了CEASE干预的总成本和每次戒烟的增量成本。使用在重复横断面中评估的2项试验结局指标评估CEASE有效性：（1）在项目启动后2周（基线）和2年随访时，通过父母报告的干预与常规护理实践评估的吸烟率变化，以及（2）基线与随访时在过去2年中实现可替宁证实戒烟的吸烟者比例的变化。采用Monte Carlo分析提供95% CI。该研究共纳入3054名参与者（基线时1523名，随访时1531名）; 2163名（70.8%）年龄在25至44岁之间，2481名（81.2%）为女性。在2年多的时间里，在5个干预措施中实施和维持CEASE的总成本为115 778美元。根据父母报告的吸烟患病率的变化，与常规治疗相比，CEASE每次戒烟的增量成本为1132美元（95%CI，653 - 3603美元），根据可替宁证实的戒烟，为762美元（95%CI，418 - 2883美元）。在基于父母报告的吸烟率的88.0%的模拟和基于可替宁确认的戒烟措施的94.6%的模拟中，在每次戒烟2000美元的支付意愿阈值下，CEASE具有成本效益。这些研究结果表明，与其他临床戒烟干预相比，CEASE干预与每次戒烟的增量成本有关。CEASE在临床儿科环境中启动和维持成本低廉，表明它对人群健康具有高度影响的潜力。
Is the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention a cost-effective way for pediatric practices to help parents quit smoking? In this economic evaluation, the CEASE intervention integrated into pediatric primary care practices had an incremental cost-effectiveness ratio of $1132 per quit. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on changes in parent-reported smoking prevalence. These findings suggest that the cost-per-quit of CEASE compares favorably to those of other smoking cessation interventions in the clinical setting. This economic evaluation examines the cost-effectiveness of a parental smoking cessation intervention delivered in pediatric primary care, compared with usual care, from a health care organization’s perspective. Parental smoking adversely affects parents’ and children’s health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization’s perspective. This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.
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影响因子：
8
作者：
Levy, Douglas E.;Winickoff, Jonathan P.;Rigotti, Nancy A.
通讯作者：
Rigotti, Nancy A.
影响因子：
8
作者：
Winickoff, Jonathan P.;Nabi-Burza, Emara;Rigotti, Nancy A.
通讯作者：
Rigotti, Nancy A.
影响因子：
158.5
作者：
Curry, SJ;Grothaus, LC;Pabiniak, C
通讯作者：
Pabiniak, C
影响因子：
4.7
作者：
Scheuermann, Taneisha S.;Richter, Kimber P.;Shireman, Theresa I.
通讯作者：
Shireman, Theresa I.
影响因子：
5.5
作者：
Rigotti, Nancy A.;Bitton, Asaf;Mort, Elizabeth
通讯作者：
Mort, Elizabeth