2003年-世界发展银行全球_Cost-Effectiveness_of_Treatment_for_Tobacco_Dependence___A_Systematic_Review_of_the_Evidence_34页_348kb

Summary of "Cost-Effectiveness of Treatment for Tobacco Dependence: A Systematic Review of the Evidence"

Core Content

This document is a systematic review of the economic evaluations of smoking cessation interventions, aimed at assessing their cost-effectiveness. It is part of the Economics of Tobacco Control series published by the World Bank and the World Health Organization's Tobacco Free Initiative. The study evaluates the quality of existing economic analyses and concludes that while many studies suffer from methodological limitations, the overall evidence supports the cost-effectiveness of smoking cessation interventions.

Main Points and Findings

• Tobacco Use and Health Impact: Smoking is a major public health threat, with an estimated 500 million of the five billion people alive in 2000 expected to die from tobacco-related causes. Tobacco control is essential to reduce this burden.

• Cost-Effectiveness of Interventions: The review finds that most studies conclude that smoking cessation interventions are cost-effective. The cost-effectiveness ratios for these interventions are generally lower than those for other health treatments.

• Quality of Studies: Many studies lack methodological rigor. Only 11 out of 22 studies explicitly state the perspective from which the analysis is conducted, and only four take a societal perspective, which is recommended for comprehensive economic evaluation.

• Outcome Measures: The most preferred measure is cost utility, which accounts for both quantity and quality of life. However, only one study used this measure. The next best is costs per life year saved, used by 15 studies. The least preferred is costs per quitter, used by seven studies.

• Interventions Analyzed: A wide range of smoking cessation interventions were evaluated, including:

  • Counselling
  • Self-help programs
  • Quit-smoking contests
  • Nicotine replacement therapy (NRT)
  • Community health education
  • Combined interventions (counselling + behavioral therapy, NRT + behavioural therapy)

• Study Populations: The populations studied varied significantly. Some included all smokers, while others focused on heavy smokers, pregnant women, or hospital patients. The age and sex distribution was mentioned in 11 studies, with a mean age ranging from 38 to 48 years and a male percentage ranging from 0% to 73%.

• Comparison with Alternatives: Interventions were often compared with usual care, placebo, school programs, or medical advice. The most common comparison was counselling vs. usual care.

• Sensitivity Analysis: The study highlights that sensitivity analysis is used to assess the reliability of cost-effectiveness estimates, and the conclusions about the cost-effectiveness of interventions are robust.

• Policy Implications: Despite concerns about the quality of economic evaluations, the review concludes that smoking cessation interventions are cost-effective. Policymakers are encouraged to implement these interventions to reduce the health and economic burden of tobacco use.

Key Information

• Objective: To evaluate the quality of economic studies on smoking cessation and determine the cost-effectiveness of these interventions.

• Methodology:

  • A comprehensive literature search was conducted from 1966 to 2000 using databases like Medline, Embase, and Cochrane.
  • The quality of studies was assessed using Drummond et al.'s (1997) criteria, focusing on:
    • Perspective: Societal, organizational, NHS, medical payer, health authority, or participants.
    • Cost Measurement: Whether costs were identified and measured accurately.
    • Effectiveness: Whether the interventions were shown to be effective before or during the evaluation.
    • Discounting and Sensitivity Analysis: Whether these were applied consistently.

• Limitations:

  • Many studies lacked a clear perspective.
  • Few used the preferred quality-adjusted life years (QALYs) measure.
  • There was a lack of consistency in how the cost-effectiveness ratios were calculated and interpreted.
  • The study populations were too diverse to allow for direct comparisons between studies.

• Recommendations:

  • Economic evaluations should adopt a societal perspective.
  • Use of QALYs as a measure of effectiveness is strongly recommended.
  • More rigorous and consistent methods are needed to improve the quality of economic evaluations in tobacco control.

Conclusion

Although the quality of economic evaluations on smoking cessation interventions is variable, the overall conclusion is that these interventions are cost-effective. This has significant implications for public health policy, especially in low- and middle-income countries, where tobacco use is increasing and the burden of disease is shifting. The findings support the need for stronger tobacco control policies, including increasing tobacco taxes, banning tobacco advertising, and providing cessation support to reduce tobacco-related harm.

Table of Key Study Characteristics

Summary of Quality Aspects

• Perspective: Only 4 studies used a societal perspective; others used organizational, NHS, or participant perspectives.
• Cost Measurement: Most studies did not clearly identify or measure costs.
• Effectiveness: The majority of studies did not establish effectiveness before conducting the economic evaluation.
• Discounting and Sensitivity Analysis: These were not consistently applied across all studies.

In conclusion, while the quality of the studies is not always high, the cost-effectiveness of smoking cessation interventions is robust and should inform public health policy decisions.