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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 戴政 | |
dc.contributor.author | Chih-Kuan Lai | en |
dc.contributor.author | 賴志冠 | zh_TW |
dc.date.accessioned | 2021-06-08T04:59:24Z | - |
dc.date.copyright | 2010-09-09 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-08-19 | |
dc.identifier.citation | 1. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service. May 2008.
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Cost-effectiveness of a hospital-based smoking cessation intervention. Med Care 1998; 36(5): 670-8. 9. Stapleton JA, Lowin A, Russell MA. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. Lancet 1999; 354(9174): 210-5. 10. Buck DJ, Richmond RL, Mendelsohn CP. Cost-effectiveness analysis of a family physician delivered smoking cessation program. Prev Med 2000; 31(6): 641-8. 11. Grandes G, Cortada JM, Arrazola A. An evidence-based programme for smoking cessation: effectiveness in routine general practice. Br J Gen Pract 2000; 50(459): 803-7. 12. Foulds J. Effectiveness of smoking cessation initiatives. Smoking cessation services show good return on investment. BMJ 2002; 324(7337): 608-9. 13. Song F, et al. Cost-effectiveness of pharmacological interventions for smoking cessation: a literature review and a decision analytic analysis. Med Decis Making 2002; 22(5 Suppl): S26-37. 14. Tran MT, et al. Modeling the cost-effectiveness of a smoking-cessation program in a community pharmacy practice. Pharmacotherapy 2002; 22(12): 1623-31. 15. Woolacott NF, et al. The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation. Health Technol Assess 2002; 6(16): 1-245. 16. Bauld L, et al. Impact of UK National Health Service smoking cessation services: variations in outcomes in England. Tob Control 2003; 12(3): 296-301. 17. Shanahan M, et al. The cost effectiveness of pharmacotherapies for smoking cessation: necessary but not sufficient? Appl Health Econ Health Policy 2003; 2(2): 76-8. 18. Swan GE, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Arch Intern Med 2003; 163(19): 2337-44. 19. Ward MM, et al. Effectiveness of a nationally implemented smoking cessation guideline on provider and patient practices. Prev Med 2003; 36(3): 265-71. 20. Zapka J, et al. Translating efficacy research to effectiveness studies in practice: lessons from research to promote smoking cessation in community health centers. Health Promot Pract 2004; 5(3): 245-55. 21. Ronckers ET, Groot W, Ament AJ. Systematic review of economic evaluations of smoking cessation: standardizing the cost-effectiveness. Med Decis Making 2005; 25(4): 437-48. 22. Kaper J, et al. Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment. Pharmacoeconomics 2006; 24(5): 453-64. 23. Olsen KR, et al. Cost-effectiveness of the Danish smoking cessation interventions: subgroup analysis based on the Danish Smoking Cessation Database. Eur J Health Econ 2006; 7(4): 255-64. 24. Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Aust N Z J Public Health 2006; 30(5): 428-34. 25. Halpern MT, Dirani R, Schmier JK. The cost effectiveness of varenicline for smoking cessation. Manag Care Interface 2007; 20(10): 18-25. 26. Myung, SK, et al. Meta-analysis of studies investigating one-year effectiveness of transdermal nicotine patches for smoking cessation. Am J Health Syst Pharm 2007; 64(23): 2471-6. 27. Hoogendoorn M, Welsing P, Rutten-van Molken MP. Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands. Curr Med Res Opin 2008; 24(1): 51-61. 28. Bolin K, et al. Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries. Eur J Public Health 2009; 19(6): 650-4. 29. Keiding H. Cost-effectiveness of varenicline for smoking cessation. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3): 215-21. 30. Smith SS, et al. Comparative effectiveness of 5 smoking cessation pharmacotherapies in primary care clinics. Arch Intern Med 2009; 169(22): 2148-55. 31. Vemer P, Rutten-van Molken M.P. Crossing Borders: Factors Affecting Differences in Cost-Effectiveness of Smoking Cessation Interventions between European Countries. Value Health 2009. 32. Bauld L, et al. The effectiveness of NHS smoking cessation services: a systematic review. J Public Health (Oxf) 2010; 32(1): 71-82. 33. Linden K, et al. Cost effectiveness of varenicline versus bupropion and unaided cessation for smoking cessation in a cohort of Finnish adult smokers. Curr Med Res Opin 2010; 26(3): 549-60. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/23338 | - |
dc.description.abstract | 背景:門診戒菸治療服務計畫自91年實施以來,為鼓勵並協助有意戒菸者接受治療,以部分給付模式提供各種不同戒菸藥物每週定額之費用補助,戒必適(varenicline)為近年新上市之戒菸輔助藥物,在隨機對照試驗中,其長期戒菸治療成功率優於既有藥物,但在現有國內給付制度下,實際推廣於臨床例行使用後之效果尚不清楚。
目的:(一)在現在部份給付(負擔)模式下,探討兩種不同戒菸輔助藥物—戒必適與克菸貼片之比較效果;(二) 在平常的臨床情境使用下,戒必適是否仍維持臨床試驗中較克菸貼片更佳之戒菸治療效果;(三) 探討任何可能的影響此兩種藥物在實際臨床情境治療成果之因素? 材料與方法:門診戒菸治療服務計畫中,自95年四月至98年十一月接受服務治療之個案,選取年齡介於20-70歲、接受戒必適或克菸貼片治療者,且其六個月後之抽樣電訪結果為合格者,合乎條件之個案戒必適組有1,117名、克菸貼片組1,211名。以開始接受治療後六個月之七日點戒菸成功率為主要結果指標,個案接受藥物處方週數為次要結果指標。 統計分析:以羅吉斯回歸進行模式進行相關因素分析。 結果:本研究六個月後之戒菸治療成功率主要受到所使用之藥物種類及其處方時間所影響,使用戒必適治療者之戒菸成功率相較於使用克菸貼片,其OR為1.48 (1.20–1.81),接受藥物處方≧4週者之戒菸成功率亦明顯高過處方<4週者甚多,其OR為2.18 (1.72–2.75),而接受服務個案之年齡較長者可略提高其戒菸成功率,年齡每增加一歲其OR為1.011 (1.002-1.020);有同住家人吸菸和尼古丁成癮度較高者,會降低戒菸成功率,其OR為分別為0.71 (0.56–0.88)與0.87(0.83–0.91)。目前門診戒菸治療服務計畫中,個案接受處方之時間戒必適為3.16±2.25週,高於克菸貼片之2.39±1.97週,兩者間具有顯著之差異 (P <0.0001),但皆遠低於臨床指引建議之標準。 討論與建議:在國內現行給付制度下,接受同等治療期間(開立處方藥物<4週或≧4週)之個案,使用戒必適之戒菸效果超出克菸貼片,其六個月後戒菸成功率之OR達1.48 (1.20–1.81),增加程度接近隨機對照試驗之結果,且使用戒必適者通常會持續接受更多週數之藥物處方,使其戒菸治療獲得加成效果。目前接受戒菸治療者普遍過早停止使用輔助藥物,而影響治療效果,在部分給付制度下,戒必適相對較為昂貴,其普及率與處方率偏低,戒菸治療服務計畫如能設法提高戒必適之使用率,應能有效提供戒菸治療成功率。 | zh_TW |
dc.description.abstract | Background: National Smoking Cessation Service (NSCS), implemented since 2002, encourages and promotes motivated smokers to participate anti-smoking treatment by partially reimbursing related pharmacotherapy. Varenicline is a novel, recently launched adjuvant for treating tobacco dependence. Its long term cessation rate is superior to traditional treatment in randomized controlled trials (RCTs). However, whether its efficacy can be translated into daily practice with a partial coverage of drug expense remains unclear.
Aim: The aim of this study is three folds: (1) To investigate the comparative effectiveness of varenicline and nicotine patch in a health care system with partial coverage; (2) To determine whether varenicline still maintain a better effectiveness than nicotine patch as it does in RCTs; (3) To identify any possible factors that influence or lead to the difference of the treatment outcome between varenicline and nicotine patch? Material and method: Eligible participants are: (1) aged 20 to 70 years; (2) those who received varenicline or nicotine patch (Nicotinell) between Apr 2006 and Nov 2009 in NSCS; and (3) qualified for the telephone follow-up made 6 months after their first visit of smoking cessation service. We recruited 1,117 participants in varenicline group and 1,211 in nicotine patch group. The primary outcome of analysis is 7-day point prevalent abstinence (PPA) at 6months. The secondary outcome is the duration of prescribed pharmacotherapy (in weeks). Statistic analysis: Logistic regression is used for association analysis to find the related factors. Result: The success of cessation at 6 months after initiating treatment is mainly determined by the type of pharmacotherapy and its duration of prescription in our study. The ORs are 1.48 (95% CI: 1.20–1.81) for varenicline group vs. Nicotinell patch group and 2.18 (95% CI: 1.72–2.75) for those with at least 4 weeks of prescribed pharmacotherapy vs. those less than 4 weeks. Older age is a modest but positive factor to enhance successful cessation. There are two negative factors to curb cessation attempt: smoker in the household (OR=0.71, 95% CI: 0.56–0.88) and higher FTND (Fagerstrom Tolerance of Nicotine Dependence) score (OR=0.87, 95% CI: 0.83–0.91). The durations of prescription are only 3.16±2.25 weeks and 2.39±1.97 weeks in varenicline and Nicotinell group respectively. Both are far below than guideline recommendation. Discussion and Suggestion: Varenicline is more effective in treating tobacco use as compared with Nicotinell patch no matter the duration of prescription is at least or less than 4 weeks in routine daily practice. The findings of this comparative effectiveness research are similar to those identified in previous RCTs. In addition, the participants who receive varenicline also tend to be more compliant than those treated with Nicotinell patch. The better compliance of varenicline will synergistically exaggerate its treatment effect. Under-treatment is a common problem in NSCS. Most participants terminate adjuvant therapy prematurely. Varenicline with partial coverage is relatively expensive and infrequently prescribed in NSCS. A new strategy to encourage the distribution and prescription of varenicline is imperative to improve the cessation rate of NSCS. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T04:59:24Z (GMT). No. of bitstreams: 1 ntu-99-P97842005-1.pdf: 716227 bytes, checksum: 3e46aec5b86394d0e4780d5169218f5e (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 第一章、前言 1
第二章 戒菸治療輔助藥物 一、尼古丁替代療法 3 二、非尼古丁戒菸輔助藥物 5 三、戒菸輔助藥物之臨床試驗 7 四、實際比較效果之探討 9 第三章、門診戒菸治療服務 一、實施內容 11 二、服務概況與效果 13 三、戒菸治療之成功率調查 15 第四章 研究目的、材料與方法 一、研究目的 18 二、個案來源與篩選 19 三、解釋變項與反應變項 21 四、統計分析 23 第五章 結果 一、電話訪查 24 二、戒菸成功率 28 三、處方戒菸藥物週數 32 第六章、討論與建議 一、討論 34 二、建議 35 三、研究限制 37 參考文獻 39 附 錄 42 | |
dc.language.iso | zh-TW | |
dc.title | 部分給付下varenicline與尼古丁貼片之比較效果 | zh_TW |
dc.title | Comparative effectiveness of varenicline and nicotine patch reimbursed partially in health service | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 張淑惠,陳秀熙,嚴明芳,黃崑明 | |
dc.subject.keyword | 戒菸治療,戒必適,尼古丁貼片,尼古丁取代治療,比較效果,給付, | zh_TW |
dc.subject.keyword | smoking cessation,varenicline,nicotine patch,nicotine replacement therapy,comparative effectiveness,reimbursement, | en |
dc.relation.page | 75 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2010-08-19 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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