Within a smoking-cessation program, what impact does genetic information on lung cancer need to have to demonstrate cost-effectiveness?

Cost Effectiveness and Resource Allocation

Research

Robert P Young¹  Nicholas G Hirst²  Louisa G Gordon²  Paul M Brown³ 

[1] Department of Medicine, Auckland Hospital, Private Bag, 92019, Auckland, New Zealand;Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Q4029, Herston, Australia;School of Population Health, The University of Auckland, Cnr Morrin & Meriton Rds, 1142, Glen Innes, Auckland, New Zealand;

关键词: Lung Cancer;    Genetic Test;    Relapse Rate;    Nicotine Replacement Therapy;    Varenicline;   

DOI  :  10.1186/1478-7547-8-18

 received in 2010-01-20, accepted in 2010-09-16,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundMany smoking-cessation programs and pharmaceutical aids demonstrate substantial health gains for a relatively low allocation of resources. Genetic information represents a type of individualized or personal feedback regarding the risk of developing lung cancer, and hence the potential benefits from stopping smoking, may motivate the person to remain smoke-free. The purpose of this study was to explore what the impact of a genetic test needs to have within a typical smoking-cessation program aimed at heavy smokers in order to be cost-effective.MethodsTwo strategies were modelled for a hypothetical cohort of heavy smokers aged 50 years; individuals either received or did not receive a genetic test within the course of a usual smoking-cessation intervention comprising nicotine replacement therapy (NRT) and counselling. A Markov model was constructed using evidence from published randomized controlled trials and meta-analyses for estimates on 12-month quit rates and long-term relapse rates. Epidemiological data were used for estimates on lung cancer risk stratified by time since quitting and smoking patterns. Extensive sensitivity analyses were used to explore parameter uncertainty.ResultsThe discounted incremental cost per QALY was AU$34,687 (95% CI $12,483, $87,734) over 35 years. At a willingness-to-pay of AU$20,000 per QALY gained, the genetic testing strategy needs to produce a 12-month quit rate of at least 12.4% or a relapse rate 12% lower than NRT and counselling alone for it to be equally cost-effective. The likelihood that adding a genetic test to the usual smoking-cessation intervention is cost-effective was 20.6% however cost-effectiveness ratios were favourable in certain situations (e.g., applied to men only, a 60 year old cohort).ConclusionsThe findings were sensitive to small changes in critical variables such as the 12-month quit rates and relapse rates. As such, the cost-effectiveness of the genetic testing smoking cessation program is uncertain. Further clinical research on smoking-cessation quit and relapse rates following genetic testing is needed to inform its cost-effectiveness.

【 授权许可】

CC BY   
© Gordon et al; licensee BioMed Central Ltd. 2010