Intervention Review

Healthcare financing systems for increasing the use of tobacco dependence treatment

  1. Ayalu A Reda2,
  2. Janneke Kaper1,
  3. Hurmuz Fikretler3,
  4. Johan L Severens4,
  5. Constant Paul van Schayck1,*

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 2 DEC 2008

DOI: 10.1002/14651858.CD004305.pub3

Database Title

Additional Information

How to Cite

Reda AA, Kaper J, Fikretler H, Severens JL, van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub3.

Author Information

  1. 1

    Care and Public Health Research Institute (CAPHRI), Department of General Practice, Maastricht, Netherlands

  2. 2

    Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands

  3. 3

    Maastricht University, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands

  4. 4

    Maastricht University, Department of Management of Health Care, Maastricht, Netherlands

*Constant Paul van Schayck, Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, P Debyeplein 1, PO Box 616, Maastricht, 6200 MD, Netherlands. Onno.vanSchayck@HAG.unimaas.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

We hypothesized that provision of financial assistance for smokers trying to quit, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts.

Objectives

The primary objective of this review was to assess the impact of reducing the costs of providing or using smoking cessation treatment by health care financing interventions on abstinence from smoking and utilization of smoking cessation treatment.

Search methods

We searched the Cochrane Tobacco Addiction group specialized register; the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2008; MEDLINE (from January 1966 to August 2008) and EMBASE (from January 1980 to August 2008) to identify trials.

Selection criteria

We included randomized controlled trials (RCTs) and controlled trials involving financial benefit interventions to smokers or their health care providers or both.

Data collection and analysis

Three reviewers independently extracted data and assessed the quality of the included studies. Rate ratios (RR) were calculated for individual studies on an intention-to-treat basis and meta-analysis was performed using a random effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives.

Main results

We found nine trials involving financial interventions directed at smokers and two studies directed at health care providers.

There was a statistically significant favourable effect of full financial interventions directed at smokers on continuous abstinence compared to no interventions with a risk ratio (RR) of 4.38 (95% CI 1.94 to 9.87). There was also a significant effect of full financial interventions when compared to no interventions on the number of participants making a quit attempt (RR 1.19; 95% CI 1.07 to 1.32; N = 3). There was a significant effect of financial interventions directed at health care providers in increasing the utilization of behavioural interventions for smoking cessation (RR 1.33; 95% CI 1.01 to 1.77). Comparison of full benefit with partial or no benefit resulted in costs per additional quitter ranging from $260 to $1453.

Authors' conclusions

Full financial interventions directed at smokers when compared to no financial interventions could increase the proportion quitting, quit attempts and utilization of pharmacotherapy by smokers. Although the absolute differences were small the costs per additional quitter were low. The methodological qualities of the included studies need to be taken into consideration in interpreting the conclusions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Do Interventions that reduce the cost of smoking cessation treatment to smokers increase quit rates, quit attempts or use of treatments

Apart from counselling and pharmacotherapy, strategies such as financial interventions could help smokers quit.

We found eight trials involving financial interventions directed at smokers and two trials directed at health care providers.

Providing full financial benefits (covering all the costs of treatment) to smokers when compared to no financial benefits increased the proportion quitting smoking, quit attempts and utilization of drug treatment by smokers.  Although the absolute differences in quitting were small, the costs per quitter were low. We did not find a difference in effect between full and partial financial benefits in increasing the use of smoking cessation treatment or abstinence from smoking. Financial benefits extended to health care providers increased the use of behavioural interventions for smoking cessation.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以金錢獎勵系統增加戒菸計畫的使用

假設提供金錢協助給嘗試戒菸的人,或給醫療端財務補貼,可以增加成功戒菸率.

目標

本次回顧的主要目的是在評估在健康照護體系下提供金錢方面的協助於戒菸計畫上以減低戒菸者及醫療端的負擔下，所產生的影響以及對戒菸計畫的使用的影響。

搜尋策略

搜尋:the Cochrane Tobacco Addiction group specialized register; the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2008; MEDLINE (from January 1966 to August 2008) and EMBASE (from January 1980 to August 2008).

選擇標準

納入所有隨機對照試驗和對照試驗,研究對抽菸者或(及)醫療端提供財務補貼。

資料收集與分析

3個檢視者獨立擷取資料並評估研究品質.每個研究都以intentiontotreat 的原則去計算Rate ratio(RR)並使用random effects model做後設分析(metaanalysis)。當研究內容有提到2個以上替代方案的成本效益時，我們也會納入經濟效益評估。

主要結論

找到9試驗對吸菸者使用金錢補助,2個對醫療端. 對吸菸者使用全額金錢補助在,持續戒菸率統計上顯著優於沒有提供補助RR:4.38 (95% CI 1.94 to 9.87).全額金錢補助組其嘗試戒菸人數顯著多於沒有提供補助 (RR 1.19; 95% CI 1.07 to 1.32; 3試驗).財務補貼之於醫療端，對於增加使用行為處遇於戒菸也產生了顯著的影響(RR 1.33; 95% CI 1.01 to 1.77)比較全額補助之於部分或沒有補助，則每額外多一個戒菸者，其花費會從$260上升到$1453.

作者結論

對吸菸者予以全額補助比起沒有補助會增加戒菸比率，增加戒菸嘗試，以及藥物治療的使用率。雖然絕對差異不大，但是每額外多一個戒菸者其總花費反而低。當然，此次納入的研究其方法學的品質在解釋結果時需要列入考慮

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

諮商和藥物治療外,金錢補助也可協助戒菸. 我們找到8個試驗對吸菸者提供金錢獎勵,2個對醫療端. 提供全額補助的方法比起沒有補助，能增加戒菸的比率。戒菸的嘗試以及藥物治療的使用率，雖然絕對戒菸的差異不大，但對每個戒菸者的花費卻相對較低，我們沒有發現全額或部分補助對於增加使用戒菸治療或是增加戒菸成功上有何差異。此外，對醫療端提供金錢補助可以增加使用戒菸行為處遇的比率。

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