臺南社區民眾衛教戒菸成本效益分析

Abstract

研究目的：依據世界衛生組織（WHO）調查顯示，全球有63%的死亡由非傳染性疾病引起，而「菸草」是其主要風險因素。在台灣，菸草及相關危害每年造成至少2萬7,000 人死亡，另約有287萬人因吸菸及二手菸罹病，足以顯現吸菸不僅影響個人健康，更會對社會造成龐大的負擔，因此菸害防制為當前公共衛生領域中刻不容緩的課題之一。為了協助吸菸者戒菸，目前發展出許多介入方式，在社區中，則以戒菸班、護理人員衛教為最常使用之介入方法。本研究以醫療經濟觀點，探討以社區為主的戒菸班及衛教諮詢做為社區衛教介入計畫之成本效益。 方法：本研究採橫斷式調查，以2019年臺南市各區衛生所辦理戒菸班及2019年接受社區戒菸衛教諮詢服務之吸菸民眾為研究對象，利用機率性成本效用分析（Probabilistic cost-utility Analysis, CUA）評估社區戒菸衛教，即「戒菸班」及「戒菸諮詢衛教」介入後相較於台南市「行動醫院-全民健檢」社區整合式篩檢之成本效益，並計算因戒菸每增加一個生活品質校正生命年所需額外付擔的成本。 結果：在提升戒菸意願部分，經由戒菸班介入後，戒菸意願有改善者占80%，惡化者占3.6%，戒菸班介入計畫之戒菸成功率為49.5%，社區戒菸衛教諮詢介入計畫之戒菸成功率12.5%。在成本效益部分，若對照組設定為未有任何介入措施時吸菸民眾之戒菸率為0%，則戒菸班介入每增加一個生活品質調整後之生命年數所需成本為新臺幣5,363元；社區戒菸衛教諮詢，每增加一個生活品質調整後之生命年數所需成本為為新臺幣1,323.4元。若進一步以參加行動醫院整合式篩檢民眾之戒菸狀況作為基礎組（戒菸率為14.4%），在不考慮生產力損失之前，戒菸班介入計畫之增量成本效用比為新臺幣9,266元，社區戒菸衛教諮詢介入計畫之增量成本效用比為新臺幣-7,273元（成本增加、效益減少），在支付意願為新臺幣10,000元時，戒菸班達到成本效益的比率為70%，在支付意願超過新臺幣30,000元時，戒菸班達到成本效益的比率為100%。若進而考慮生產力損失後，則戒菸班之增量成本效益比屬於優勢策略（效益增加、成本減少），在任何支付意願下，戒菸班符合成本效益的比例達100%。 結論：本研究顯示戒菸班介入計畫確實能提升民眾戒菸意願，且戒菸成功率較社區戒菸衛教諮詢服務介入計畫高。在成本效益部分，在考慮生產力損失後，戒菸班更具成本效益。

Objective: According to a World Health Organization （WHO） survey, 63% of deaths are caused by non-communicable diseases in worldwide, and tobacco is the main risk factor. Smoke contains more than 7,000 chemical components, at least 250 of which are known to be harmful, and more than 69 cause cancer. In Taiwan, tobacco and related hazards cause at least 27,000 deaths each year, 2.87 million people were ill because of smoking and second-hand smoke. It shows that smoking not only affects personal health, but also causes a huge burden on society. Therefore, the tobacco control is one of the urgent issues in the current public health. In order to assist smokers to quit smoking, there are many effective interventions, including group therapy, personal consultation, telephone consultation, physician counseling, nursing health education, self‐help smoking cessation, nicotine and non-nicotine replacement therapy. However, group therapy and smoking counseling services in community are the most commonly used intervention methods in the community. In this study, the effectiveness of group therapy and smoking counseling services in community, as personalized health education intervention programs, was discussed in the view of medical economics. Research design and method: This study uses a cross-sectional survey, taking group therapy conducted by public health centers in Tainan City in 2019 and smoking counseling services in community in 2019 as the research object. Using probabilistic cost-utility analysis method to evaluate the cost-effectiveness of the personalized health education, as group therapy and smoking counseling services in community. The cost-effectiveness of the intervention program is compared with Tainan community-based integrated screening （called mobile hospital）. The benefits of the intervention program are expressed in terms of the increased quality-adjusted life year after smoking cessation. Results: In the part of cessation intention, after intervened by group therapy, 80% of the participants are improved, and 3.6% worsened. In the cost-effectiveness part, we assumed that without any intervention, the smoking cessation rate of smokers is 0%. The quit rate of group therapy is expected to achieve 49.5%. The cost for each additional quality-adjusted life year is NT$ 5,362.57. The quit rate of quitting smoking in the smoking counseling services in community is 12.5 %, the cost of each additional quality-adjusted life year is NT$ 1,323.4. If the smoking cessation status of people participating in mobile hospital is further used as the basic group （the smoking cessation rate is 14.4%）. Considering the cost of being unable to work due to reduced QALY, the estimated incremental cost-benefit ratio of the group therapy is NT$9,266, and the smoking counseling services in community is NT$-7,273 （increased cost and reduced benefit）. The cost-effective proportion of group therapy is almost 100%. Regardless of the cost of being unable to work after reduced QALY, if the willingness-to-pay is NT$10,000, the rate of cost-effectiveness of group therapy is about 70% and if the willingness-to-pay is over NT$30,000, the rate of cost-effectiveness of group therapy is achieved 100%.If we consider the cost of being unable to work after reduced QALY, the incremental cost-benefit ratio of the group therapy falls in the fourth quadrant. Under any willingness to pay, the cost-effective ratio of the smoking cessation class reaches 100 %. Conclusion: This study shows that the group therapy intervention can indeed increase people's cessation intense, and the quit rate in higher than community health education and consultation service intervention plan. Taking into account the cost of being unable to work due to reduced QALY, group therapy are more cost-effectiveness and can be widely used in the community.