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歡迎來到我的部落格。我會在這裡分享病人戒菸的經驗,以及一些比較專業的知識。
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暱稱:泡泡龍
個人介紹:因為喜歡潛水,潛水會產生許多泡泡,加上我屬龍,所以自稱泡泡龍

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戒菸的成本效益
分類:菸害訊息
泡泡龍(fjguo) | 2007/11/13 下午 11:02:36

在出去演講戒菸的時候,常常有人問我戒菸符不符合成本效益?國健局花了這麼多錢作戒菸,有沒有實證醫學的基礎?衛生署把大部分的菸捐拿去補貼健保而忽視戒菸治療,是不是正確的政策?

Franco 等人利用Framingham Heart Study及Framingham Offspring Study的資料計算心臟血管疾病初級預防的成本效益,發現戒菸比阿斯匹林,血壓控制及Statin(降血脂藥物)都更具有成本效益[1]。

一個心肌梗塞後病人戒菸成效的統合分析(meta-analysis),包括12個研究,5,878位病人,發現戒菸對預防死亡的勝算比是0.54,血栓溶解治療是0.75,阿斯匹林治療是0.77,β阻斷劑是0.88,故戒菸是預防心肌梗塞病人死亡最有效的方法[2]。

美國Mayo Clinic追蹤5,544位病人,發現戒菸拯救一年生命花費2,587至6,828美金,比大多數醫療介入更具成本效益(表一)[3]。

台灣薛光傑醫師的研究發現,國民健康局門診戒菸服務每拯救一年生命花費7,996台幣,遠低於國外的報告[4]。黃雅慧的研究則顯示門診戒菸服務10個月花費7千5百萬元台幣,15年內的淨效益為6億5千2百萬元台幣,是非常符合成本效益的計畫[5]。

戒菸比其他慢性病治療具有成本效益是很容易推估的,因為戒菸治療是短暫的,只花費二至三個月的費用,卻有一輩子的效益。相較之下,一般慢性病治療需要終生服藥,其花費自然比較高。所以戒菸具有較高的成本效益,是無庸置疑的。

1. Franco OH, der Kinderen AJ, De Laet C, Peeters A, Bonneux L. Primary prevention of cardiovascular disease: cost-effectiveness comparison. Int J Technol Assess Health Care. 2007;23:71-9
2. Wilson K, Gibson N, Willan A, Cook D. Effect of Smoking Cessation on Mortality After Myocardial Infarction: Meta-analysis of Cohort Studies. Arch Intern Med 2000;160:939-44
3. Croghan IT, Offord KP, Evans RW, Schmidt S, Gomez-Dahl LC, Schroeder DR, et al. Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clin Proc 1997;72:917-24
4. 薛光傑,門診戒菸之成效與成本效果分析。未發表論文,2007
5. 黃雅慧,國民健康局門診戒菸之成本效益分析。國立陽明大學碩士論文,2004

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