Cost-effectiveness of smoking cessation therapy (SCT) in Japan Hideo - - PowerPoint PPT Presentation

• Cost-effectiveness of smoking cessation

therapy (SCT) in Japan

Hideo Tanaka1, Chie Taniguchi2, Isao Oze1, Hidemi Ito1, Hideo Saka2.

• 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

4weeks 2weeks 2weeks 4weeks 1st 2nd 3rd 4th 5th nicotine patch

• r

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

• (3) Costs of drugs and fees for pharmacists’ instruction to the patients

( ) ( ) { }

clinics into insurance health by ent reimbursem patients the by paid Charge + ≈

• Characteristics of 907 study subjects

None (138) Psychiatric disease (188) Cancer (163) Respiratory

• dis. (128)

Cardiovascular dis. (91) The others (199) Present illness 15.2% 20.7% 18.0% 14.1% 10.0% 21.9% None (8) Varenicline (755) Nicotine patch (144) Prescription 83.2% 15.8% 1.0%

• Compliance of SCT among 907 study subjects

100 89 79 65 53

50 100

1st 2nd 3rd 4th 5th

Participation rate of SCT in the 5 sessions (%)

2weeks 2weeks 4weeks 4weeks

• Compliance of SCT among 907 study subjects

by present illness

50 100 1st 2nd 3rd 4th 5th

Cardiovascular dis. Cancer Respiratory dis. The others None Psychiatric dis.

Participation rate of SCT in the 5 sessions (%) 63 57 57 54 50 45

• 24%

32% 19% 24% 20% 29%

0% 10% 20% 30% 40% None (138) Cancer (163) Cardiovascular

• dis. (91)

Respiratory

• dis. (128)

Psychiatric

• dis. (188)

The others (199)

Success rate of smoking cessation by present illness

• Cost of SCT by present illness

¥ 3 . 52 M

\ 1.48 M \ 1.93 M

\ 1.11 M

\ 1.58 M \ 2.12 M \ 2.34 M \ 2.11 M \ 2.70 M \ 1.54 M \ 2.06 M \ 2.80 M \ 3.21 M \ 3.52 M \ 4.65 M \ 2.67 M \ 3.50 M \ 4.50 M \ 5.52 M

¥ . 00 million ¥ 5 . 00 million ¥ 10 . 00 million

None (n=138) Cancer (n=163) Cardiovascular D. (n=91) Respiratory D. (n=128) Psychiatric D. (n=188) The others (n=199)

Personal expenses Other costs in clinics Costs of drugs and pharmacists

\ 7.11million \ 9.28million \ 5.32million \ 7.14million \ 9.42million \ 11.07million

• Cost to provide one quitter by present illness in the

Japanese SCT

¥ 54 , 382 ¥ 51 , 522 ¥ 56 , 922 ¥ 58 , 506 ¥ 55 , 763 ¥ 50 , 087 ¥ 55 , 589 ¥ 216 , 337 ¥ 215 , 457 ¥ 178 , 430 ¥ 313 , 178 ¥ 230 , 245 ¥ 247 , 798 ¥ 194 , 075 100,000 200,000 300,000 Cost of SCT per patients Cost to provide one quitter in SCT

(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.