哮喘联盟

   摘要
   背景：2011年，药物治疗作为戒烟治疗的组成部分之一被加入到荷兰的基本医疗保险体制中。本研究调查加入到行为疗法中的药物治疗的成本效益。
   方法：我们收集戒烟治疗项目供应商的数据以及健康保险公司Achmea的成本信息，并进行观察性研究。国家戒烟机构、全科医生以及医疗保健中心提供四种不同服务项目：（i）行为治疗；（ii）行为治疗结合尼古丁替代治疗（NRT）；（iii）行为疗法结合戒烟帮助（药物）（SCA）；（iv）行为疗法结合NRT和SCA。主要自变量是治疗方法，主要结局指标是是否成功戒烟。我们采用Logistic回归分析和logistic多层次分析的方法评估不同戒烟疗法的有效性。采用Bootstrapping法计算成本效益。
   结果：我们的研究结果显示，行为疗法结合SCA比参考方法（单独使用行为疗法）的戒烟效果更好，并且对全科医生和医疗保健中心来说都是成本效益最高的治疗方法。行为治疗结合NRT的治疗效果也比单独使用行为疗法更好，但是两者之间的差别较小。
   结论：行为疗法结合SCA似乎是最成功的戒烟疗法。但是，由于本项目属于观察性研究，还不能得出关于不同戒烟疗法之间成本效益差别的确切结论。以后还应该针对吸烟者类型（吸烟史、每天吸烟的数量等）进行分组研究。
 

（刘国梁 审校）
Eur J Public Health. 2014 Dec 3. pii: cku200. [Epub ahead of print]


 

Effectiveness of pharmacotherapy in behavioural therapeutic smoking cessation programmes.
 

Oostveen R1, van der Galiën OP2, Smeets HM3, Hollinga AP2, Bosmans JE4.
 

ABSTRACT
BACKGROUND:In 2011, pharmacotherapy as a part of smoking cessation treatment was reimbursed through the basic health insurance in the Netherlands. We examine the (cost)-effectiveness of pharmacotherapy added to behavioural therapy.
METHODS: An observational study was conducted using data from the suppliers of the smoking cessation programmes together with information on costs from health insurance company Achmea. National suppliers, general practitioners and healthcare centres offered four different programmes. (i) Behavioural support (=therapy); (ii) Behavioural support combined with nicotine replacement therapy (NRT); (iii) Behavioural support combined with smoking cessation aids (=medication) (SCA); (iv) Behavioural support combined with NRT and SCA. The primary independent variable was the programme type, and the primary outcome was whether someone quitted smoking. To examine the effectiveness of the different programmes logistic regression and logistic multilevel analyses were performed. Bootstrapping was used to evaluate cost-effectiveness.
RESULTS:The results indicate that behavioural support combined with SCA has more quitters than the reference programme of behavioural support alone, and it also seems the most cost-effective programme for general practitioners and healthcare centres. Behavioural therapy combined with NRT had also more quitters, although the difference with the reference programme was smaller.
CONCLUSION:Behavioural support combined with SCA seems the most successful programme. However, as we performed an observational study, firm conclusions about the differences in effectiveness between the programme types cannot be made. Future research should consider the type of smoker (smoking history, amount of cigarettes per day).
 

Eur J Public Health. 2014 Dec 3. pii: cku200. [Epub ahead of print]