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PSM1 |
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COST-EFFECTIVENESS ANALYSIS
FOR SMOKING CESSATION THERAPY IN JAPAN
Igarashi A1, Takuma H1, Fukuda T1, Oshima
A2, Nakamura M3, Tsutani K, 1Tokyo University,
Bunkyo, Tokyo, Japan, 2Osaka Medical Center for
Cancer and Cardiovascular Diseases, Osaka, Japan,
3Osaka Medical Center for Health Science and
Promotion, Osaka, Japan
OBJECTIVE:
To evaluate cost-effectiveness of
nicotine-replacement therapy (NRT). METHODS:
We
developed Markov-model to analyze lifetime costs
and effectiveness expressed in life-year gained.
With expert interview, we developed a
Markov-model. We only included direct medical cost
from the perspective of health care payer. We
identified 19 tobaccoassociated diseases,
including ten cancers based on “Health Risk
Appraisal for Japanese People” developed by
Nakamura-Oshima in 2000. One cycle of Markov model
was set to five years. We assumed hypothetical
cohort who started smoking at the age of 20. They
participate in NRT at the age of 30-70. We
terminated analysis at the age of 90. We
discounted both cost and outcome at 3% annually.
In addition to cost-effectiveness of NRT, we
calculated annual excess loss in medical cost
caused by tobacco. RESULTS:
Annual excess loss in
medical cost caused by tobacco was estimated as
JPY500 bil. Focusing on one person, tobacco
reduced their life-expectancy for 1.9 years for
male and 1.0 year for female, increased their
lifetime medical costs for JPY 2.4 mil. for male
and JPY 1.2 mil. for female. We found that NRT was
more effective and cost-effective for those who
intended to stop smoking than for others. For
male, NRT saves life time medical costs for JPY
270,000 and expand life-expectancy for 0.19 years.
For female, NRT saves life time medical costs
(direct medical cost only) for JPY 136,000
(768,000 vs 631,000) and expand life-expectancy
for 0.12 years (23.7y vs 23.5y). Various
sensitivity analyses showed robustness of our
results. CONLUSIONS:
NRT is dominant to control
for smoking cessation therapy. In the future, we
will undertake cost-utility analysis to evaluate
smoking cessation therapy using this model. |
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