应用伐尼克林戒烟：额外12周应用伐仑克林维持戒烟的成本－效益分析
2009/08/11
研究目的：我们在已经完成12周伐尼克林治疗并且成功戒烟的人群中，评估额外12周伐尼克林 治疗的成本－效益。
设计：采用戒烟对预后影响的模拟模型来模拟戒烟的直接和间接影响。所有结果以2003年的瑞典物价进行计算。
时间与地点：瑞典。2003年。
参与者或患者：本项队列研究包括25％的被动员戒烟的成人吸烟者（168,844 名男性，208,737名女性）。年龄和性别分布反应了2003年的瑞典人口状况。
干预措施：对接受12周开放标记伐尼克林治疗的、成功戒烟至少7天的吸烟者再进行为期12周的伐尼克林或安慰剂治疗。
检测与结果：与单纯12周伐尼克林治疗组相比，在50年的时间范围内，额外12周伐尼克林治疗组在每个质量调整生命年（QALY）内支出的增加：男性为7066欧元，女性为7108欧元（1欧元约等于9.12瑞典克朗）。该估计值排除了生存时间延长所造成的生产和消费的间接影响。每个QALY相对应的支出增加值（包括间接支出）分别为24,149和24,436欧元。敏感性分析显示，估计的成本－效益比较高，但对治疗效率和干预成本相对敏感。
结论：对于已接受过12周伐尼克林治疗且已经成功戒烟的参与者，额外进行12周的伐尼克林治疗对成本－效益比的增加程度相对较低。
（陈欣 审校）
Bolin K, et al. J Eval Clin Pract. 2009 Jun;15(3):478-485.
Smoking-cessation therapy using varenicline: the cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence.
Bolin K, Mörk AC, Wilson K.
Lund University Centre for Health Economics, Lund, Sweden. kristian.bolin@luche.lu.se
STUDY OBJECTIVES: To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment.
DESIGN: The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation. All calculations were performed in 2003 Swedish prices.
SETTING: Sweden in 2003.
PATIENTS OR PARTICIPANTS: The modelled cohort consisted of 25% of adult smokers motivated to quit smoking (168,844 males and 208,737 females). The age and sex distributions of the cohort reflect that of the Swedish population in 2003.
INTERVENTIONS: Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were randomized to receive an additional 12-week treatment with either varenicline or placebo.
MEASUREMENTS AND RESULTS: The incremental costs per quality-adjusted life-year (QALY) gained, for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks, were Euro 7066 for men and Euro 7108 for women, over a 50-year time horizon. (1 Euro approximately equal to SEK 9.12). These estimates excluded indirect effects on production and consumption of increased survival. The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436, respectively. Sensitivity analysis indicated that the estimated cost-utility ratios are robust, but relatively sensitive to treatment efficiency and intervention costs.
CONCLUSIONS: An additional 12-week course of varenicline treatment, provided to abstainers after an initial 12-week treatment, produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments.
