Cost-effectiveness of enhancing a Quit-and-Win smoking cessation program for college students.
Cost-effectiveness of enhancing a Quit-and-Win smoking cessation program for college students.
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加强大学生“戒烟双赢”戒烟计划的成本效益。
DOI：
10.1007/s10198-018-0977-z
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Thomas,JanetL
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文献类型：
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作者：
Popp,Jonah;Nyman,JohnA;Luo,Xianghua;Bengtson,Jill;Lust,Katherine;An,Lawrence;Ahluwalia,JasjitS;Thomas,JanetL
目的我们进行了一个成本效益分析和基于模型的成本效用和成本效益分析的增加剂量（3比1连续比赛）和增强内容（补充戒烟咨询）的戒烟和赢比赛使用的数据从随机对照试验招募大学生在美国。方法：在成本效用和成本效益分析中，我们使用了当前和既往吸烟者生命过程的微观模拟模型，将试验结束时观察到的每个治疗组参与者（N= 1217）持续戒烟持续时间的分布转化为预期的质量调整生命年（Qs）和成本以及增量净货币效益（INMB）。试验中缺失的观察结果被归类为吸烟。在我们的参考案例中，我们从社会角度出发，使用3%的成本和收益折扣率。进行了概率敏感性分析（PSA），以解释模型和试验估计参数的不确定性。我们还使用干预的直接成本和两个基于试验的中间戒烟估计值进行了成本-效果分析（每增加一次中间戒烟的成本）：（a）6个月的生化验证（BV）连续戒烟率和（B）6个月时BV 30天点戒烟率。结果多项竞赛的6个月持续戒烟率显著高于对照组（RD 0. 04），每次戒烟的成本为1275，且持续戒烟的持续时间延长;在长期运行中，多项竞赛的平均收益为0. 03 QALY，且均为成本节约;分析中的参数不确定性，对于QALY的任何现实支付意愿（WTP），预期INMB均大于1000。结论假设缺失值是吸烟，多个比赛似乎占主导地位的一个单一的比赛从社会的角度来看。寻求通过资助大学环境中的退出和赢竞赛来促进人口健康的资助机构应该强烈考虑提供多个连续的竞赛。需要进一步的研究来评估多个比赛相比，没有比赛。
Objectives We conducted a cost-effectiveness analysis and model-based cost–utility and cost–benefit analysis of increased dosage (3 vs. 1 consecutive contests) and enhanced content (supplemental smoking-cessation counseling) of the Quit-and-Win contest using data from a randomized control trial enrolling college students in the US. Methods For the cost–utility and cost–benefit analyses, we used a microsimulation model of the life course of current and former smokers to translate the distribution of the duration of continuous abstinence among each treatment arm’s participants observed at the end of the trial (N= 1217) into expected quality-adjusted life-years (QALYs) and costs and an incremental net monetary benefit (INMB). Missing observations in the trial were classified as smoking. For our reference case, we took a societal perspective and used a 3% discount rate for costs and benefits. A probabilistic sensitivity analysis (PSA) was performed to account for model and trial-estimated parameter uncertainty. We also conducted a cost-effectiveness analysis (cost per additional intermediate cessation) using direct costs of the intervention and two trial-based estimates of intermediate cessation:(a) biochemically verified (BV) 6-month continuous abstinence and (b) BV 30-day point prevalence abstinence at 6 months. Results Multiple contests resulted in a significantly higher BV 6-month continuous abstinence rate (RD 0.04), at a cost of 1275peradditionalquit,andincreasedthedurationofcontinuousabstinenceamongquitters.Inthelongrun,multiplecontestsleadtoanaveragegainof0.03QALYsandwerecostsaving.Incorporatingparameteruncertaintyintotheanalyses,theexpectedINMBwasgreaterthan 1000 for any realistic willingness to pay (WTP) for a QALY. Conclusions Assuming missing values were smoking, multiple contests appear to dominate a single contest from a societal perspective. Funding agencies seeking to promote population health by funding a Quit-and-Win contest in a university setting should strongly consider offering multiple consecutive contests. Further research is needed to evaluate multiple contests compared to no contest.