Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases
Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases
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DOI：
10.1371/journal.pone.0148750
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发表时间：
2016-02-24
期刊：
影响因子：
3.7
通讯作者：
Chevreul, Karine
中科院分区：
文献类型：
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作者：
Cadier, Benjamin;Durand-Zaleski, Isabelle;Chevreul, Karine
背景 在法国，每年有超过 70,000 人死于与吸烟有关的疾病，而且自 2005 年以来，烟草流行率有所上升。提供免费戒烟治疗将减轻这一负担。我们研究的目的是估计提供免费戒烟治疗的增量成本效益比（ICER），同时考虑与减少与吸烟有关的三种主要疾病：肺癌、慢性阻塞性肺病（COPD）和心血管疾病（CVD）相关的成本抵消。为了衡量这一措施的财务影响，我们还进行了概率预算影响分析。方法和结果我们使用马尔可夫状态转换模型进行了成本效益分析，将免费戒烟治疗与法国法定健康保险提供的现有覆盖范围（原文如此）50 进行了比较，同时考虑到当前法国 15-75 岁吸烟者的成本抵消。我们的结果以生命周期内每增加生命年 (LYG) 的 2009 欧元增量成本效益比来表示。我们估计了基本情况并进行了蒙特卡罗敏感性分析以解释不确定性。假设参与率为 7.3%，则基本情况下免费获得戒烟治疗的 ICER 值为每 LYG 3,868（原文如此）。参数的变化提供了每 LYG 从 -(sic)736 到 (sic)15,715 的 ICER 值范围。在 99% 的情况下，完全覆盖的 ICER 低于（原文如此）每 LYG 11,187。概率预算影响分析显示，在五年范围内，肺癌、慢性阻塞性肺病和心血管疾病的潜在成本节省范围为 1500 万至 2.15 亿，初始戒烟治疗成本为 1.25 亿至 4.21 亿。结论结果表明，为尝试戒烟的吸烟者提供医疗支持非常具有成本效益，甚至可能节省成本。
ContextIn France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis.Methods and FindingsWe performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of (sic)50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was (sic)3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -(sic)736 to (sic)15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than (sic)11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from (sic)15 million to (sic)215 million at the five-year horizon for an initial cessation treatment cost of (sic)125 million to (sic)421 million.ConclusionThe results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.