Simulation-Based Estimates of Effectiveness and Cost-Effectiveness of Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease 英文参考文献.docVIP

Simulation-BasedEstimatesofEffectivenessandCost- EffectivenessofSmokingCessationinPatientswith ChronicObstructivePulmonaryDisease KokuviAtsou1,2,ChristosChouaid1,2,3,GillesHejblum1,2,4 * 1INSERM,U707,Paris,France,2UPMCUnivParis06,UMRS707,Paris,France,3AP-HP,Ho?pitalSaintAntoine,ServicedePneumologie,Paris,France,4AP-HP,Ho?pital SaintAntoine,Unite′ deSante′ Publique,Paris,France Abstract Background:Themedico-economicimpactofsmokingcessationconsideringasmokingpatientwithchronicobstructive pulmonarydisease(COPD)ispoorlydocumented. Objective:Here,consideringaCOPDsmokingpatient,thespecificburdenofcontinuoussmokingwasestimated,aswellas theeffectivenessandthecost-effectivenessofsmokingcessation. Methods:Amulti-stateMarkovmodeladoptingsociety’sperspectivewasdeveloped.SimulatedcohortsofEnglishCOPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were comparedtoidenticalcohortsofpatientswhoquitsmokingatcohortinitialization.Lifeexpectancy,qualityadjustedlife- years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: ￡/QALY) were estimated, considering smokingcessation programs with various possible scenarios of success ratesandcosts. Sensitivityanalyses included the variationofmodelkeyparameters. Principal Findings: At the horizon of a smoking COPD patient’s remaining lifetime, smoking cessation at cohort intitialization,relapsesbeingallowedasobservedinpractice,wouldresultingains(mean)of1.27life-yearsand0.68QALY, andinducesavingsof21824￡/patientinthedisease-relatedcosts.ThecorrespondingICERwas22686￡/QALY.Smoking cessationresultedin0.72,0.69,0.64and0.42QALYrespectivelygainedpermild,moderate,severe,andverysevereCOPD patient,butwasneverthelesscost-effectiveformildtosevereCOPDpatientsinmostscenarios,evenwhenhypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon,theburdenofcontinuoussmokinginEnglishCOPDpatients