simulation-based estimates of effectiveness and cost-effectiveness of smoking cessation in patients with chronic obstructive pulmonary disease基于仿真的估计的有效性和成本效益在慢性阻塞性肺疾病患者戒烟.pdfVIP

Simulation-Based Estimates of Effectiveness and Cost- Effectiveness of Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease Kokuvi Atsou1,2, Christos Chouaid1,2,3, Gilles Hejblum1,2,4* ˆ ˆ 1 INSERM, U707, Paris, France, 2 UPMC Univ Paris 06, UMR S 707, Paris, France, 3 AP-HP, Hopital Saint Antoine, Service de Pneumologie, Paris, France, 4 AP-HP, Hopital ´ ´ Saint Antoine, Unite de Sante Publique, Paris, France Abstract Background: The medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. Objective: Here, 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. Methods: A 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 Findings: At 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-yea