Simulation-Based Estimates of Effectiveness and Cost-Effectiveness of Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease

BackgroundThe medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. ObjectiveHere, considering a COPD smoking patient, the specific burden of continuous smoking was estimated, as well as the effectiveness and the cost-effectiveness of smoking cessation. MethodsA multi-state Markov model adopting society's perspective was developed. Simulated cohorts of English COPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were compared to identical cohorts of patients who quit smoking at cohort initialization. Life expectancy, quality adjusted life-years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: £/QALY) were estimated, considering smoking cessation programs with various possible scenarios of success rates and costs. Sensitivity analyses included the variation of model key parameters. Principal FindingsAt the horizon of a smoking COPD patient's remaining lifetime, smoking cessation at cohort intitialization, relapses being allowed as observed in practice, would result in gains (mean) of 1.27 life-years and 0.68 QALY, and induce savings of −1824 £/patient in the disease-related costs. The corresponding ICER was −2686 £/QALY. Smoking cessation resulted in 0.72, 0.69, 0.64 and 0.42 QALY respectively gained per mild, moderate, severe, and very severe COPD patient, but was nevertheless cost-effective for mild to severe COPD patients in most scenarios, even when hypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon, the burden of continuous smoking in English COPD patients was estimated to cost a total of 1657 M£ while 452516 QALY would be simultaneously lost. ConclusionsThe study results are a useful support for the setting of smoking cessation programmes specifically targeted to COPD patients.背景 针对合并慢性阻塞性肺疾病（COPD）的吸烟患者，戒烟的医药经济学影响相关研究记载极为匮乏。研究目的 本研究针对合并COPD的吸烟患者，估算持续吸烟带来的特异性疾病负担，并评估戒烟的临床有效性与成本效益。研究方法 本研究构建了采用社会视角的多状态马尔可夫（Markov）模型。将模拟队列中英格兰地区的活动性吸烟COPD患者（涵盖所有疾病严重程度分层，或仅纳入初始严重程度一致的患者），与队列入组时即戒烟的同质性患者队列进行对照。针对不同成功率与成本的戒烟干预方案场景，分别估算队列的预期寿命、质量调整生命年（QALY）、疾病相关医疗成本，以及增量成本效果比（ICER：英镑/质量调整生命年）。敏感性分析涵盖模型关键参数的波动范围测试。主要研究结果 以吸烟COPD患者的剩余寿命为研究时限，队列入组初始时即启动戒烟（允许临床实践中观察到的复吸情况）可使患者平均预期寿命延长1.27年，质量调整生命年增加0.68，同时每位患者可节省疾病相关医疗成本1824英镑，对应的增量成本效果比为-2686英镑/QALY。针对轻度、中度、重度及极重度COPD患者，戒烟分别可使其获得0.72、0.69、0.64及0.42个QALY；但在绝大多数场景下，戒烟对于轻至重度COPD患者均具备成本效益，即便假设采用高成本、低成功率的戒烟干预方案亦是如此。以10年为研究时限，英格兰地区吸烟COPD患者因持续吸烟产生的总疾病负担高达16.57亿英镑，同时将损失452516个QALY。研究结论 本研究结果可为针对COPD患者的专属戒烟干预方案制定提供有力的决策支持。