Cost-effectiveness of smoking cessation therapy (SCT) in Japan Hideo Tanaka 1 , Chie Taniguchi 2 , Isao Oze 1 , Hidemi Ito 1 , Hideo Saka 2 . 1. Aichi Cancer Center Research Institute, Nagoya, Japan 2. Nagoya Medical Center, Nagoya, Japan Purpose : To estimate the cost per additional smoker who succeeded to quit smoking due to the SCT, that was introduced in Japan. �
1. Smoking Cessation Therapy (SCT) in Japan. (1) When was it started? ! The National health insurance system introduced reimbursement for 70% of charge in the SCT in April 2006. (2) To whom is it provided? The following conditions are needed for receiving the SCT. 1) Those who are highly nicotine dependent which is tested by self- administered questionnaire of “Tobacco Dependence Screener” (TDS) : 5 score <=. 2) Those who meet Brinkman Index : 200 <=. 3) Those who are willing to quit smoking within 30 days. 4) Those who make written consent to receive SCT. �
1. Smoking Cessation Therapy (SCT) in Japan. (3) The SCT includes: ! behavioral counseling by trained nurse (10-30 min. per session) ! prescription of varenicline for 12 weeks or nicotine patch for 8 weeks ! measurement of CO concentration in exhalation (4) Schedule of the SCT 1st 2nd 3rd 4th 5th 2weeks 2weeks 4weeks 4weeks nicotine patch or varenicline �
2. Success rate of the SCT Among 907 smokers who started receiving SCT between April 2008 and August 2011, those who replied that “ I did not smoke during the past week.” by mail-based questionnaire at 6 month after the termination of SCT were defined as a quitter. Those who (1) dropped out during the SCT, (2) did not reply the questionnaire, and (3) replied that “ I smoked during the past week, were defined as a smoker. 3. Calculation of cost for SCT includes: (1) Personal expenses for physicians (\5,000/h) and nurses (\2500/h) (2) Other costs spent in the SCT out patient clinics { ( Charge paid by the patients ) ( reimbursem ent by health insurance ) into clinics } ≈ + � (3) Costs of drugs and fees for pharmacists’ instruction to the patients �
Characteristics of 907 study subjects Cardiovascular dis. (91) � Present None Psychiatric Cancer Respiratory The others illness (138) disease (188) (163) dis. (128) (199) 15.2% 20.7% 18.0% 14.1% 10.0% 21.9% None (8) Varenicline Nicotine Prescription (755) patch (144) 1.0% 83.2% 15.8% �
Compliance of SCT among 907 study subjects 100 Participation rate of SCT in the 5 sessions 100 89 (%) 79 65 53 50 0 1st 2nd 3rd 4th 5th 2weeks 2weeks 4weeks 4weeks �
Compliance of SCT among 907 study subjects by present illness 100 (%) Participation rate of SCT in the 5 sessions 63 57 57 54 50 50 45 Cardiovascular dis. Cancer Respiratory dis. The others None Psychiatric dis. 0 1st 2nd 3rd 4th 5th �
Success rate of smoking cessation by present illness 40% 32% 30% 29% 24% 24% 20% 20% 19% 10% 0% None Cancer Cardiovascular Respiratory Psychiatric The others (138) (163) dis. (91) dis. (128) dis. (188) (199) �
Cost of SCT by present illness ¥ 3 . 52 M ¥ 0 . 00 million ¥ 5 . 00 million ¥ 10 . 00 million None \ 1.48 M \ 2.11 M \ 3.52 M \ 7.11million (n=138) Cancer \ 9.28million \ 1.93 M \ 2.70 M \ 4.65 M (n=163) Cardiovascular D. \ 1.54 M \ 2.67 M \ 1.11 M \ 5.32million (n=91) Respiratory D. \ 1.58 M \ 2.06 M \ 3.50 M \ 7.14million (n=128) Psychiatric D. \ 2.12 M \ 2.80 M \ 4.50 M \ 9.42million (n=188) The others \ 11.07million \ 2.34 M \ 3.21 M \ 5.52 M (n=199) Personal expenses Other costs in clinics Costs of drugs and pharmacists �
Cost to provide one quitter by present illness in the Japanese SCT Cost of SCT per patients Cost to provide one quitter in SCT 178 300,000 , 313 ¥ 798 245 , 247 337 457 200,000 , 230 ¥ , , 075 216 215 ¥ 430 , ¥ ¥ 194 , 178 ¥ ¥ 100,000 506 922 763 589 382 522 087 , , , , 58 , 56 , 55 , 55 54 51 50 ¥ ¥ ¥ ¥ ¥ ¥ ¥ 0 (yen) ��
Discussion ! Average cost to provide one quitter in the Japanese SCT was \ 216,337 ( ≈ CAD 2,704). ! It was relatively high in patients with cardiovascular diseases (\ 313,178 ≈ CAD 3,915), relatively low in patients with cancer (\ 178,430 ≈ CAD 2,230). As smoking cessation can reduce risk of post-operative complication, deterioration of cardiovascular and respiratory diseases, second primary cancer, and it can prolong disease-free survival, the SCT in Japan is likely to be costly effective for smokers who got chronic diseases. ��
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