Trabajando con nuestros pacientes fumadores en atencion primaria. Un analisis de coste-efectividad

Objective: The aim of this work is to realize an economic evaluation of the smoking interventions in Primary Care (PC). Design: Cost-Effectiveness Analysis comparing two intervention strategies; intensive and brief. Setting: Patients in a general practitioner's list in a peri-urban Health Centre. Participants: All the medical histories labelled as smokers; 235 and 37 in the group of brief and intensive intervention respectively. Interventions: The brief intervention (BI) was made in the context of consultation for another purpose (1-5 minutes). The intensive intervention (II) was exclusively for smoking consultation (10-15 minutes). Main measurements: The effectiveness data are obtained by the evaluation of intervention for smokers, in a general practitioner's list, after 6 years. We employ direct sanitary costs. We exclude drugs, non- sanitary and indirect costs. We apply the valuation of incremental cost-effectiveness ratio (ICER) of the brief interventions, intensive and total (brief + intensive) to compare not taking part with each type of intervention and II with regard to BI and probabilistic analysis to treat the uncertainty. Results: The total cost per abstinent patient was 406,74 : 129,83 for BI and 1.034,99 for I.I. ICER Total intervention = 498, 87/patient who stops smoking. ICER BI = 235, 32/patient who stops smoking. ICER II = 1.232, 85/patient who stops smoking. ICER II/BI = 7.772,25/patient who stops smoking. Conclusions: Smoking interventions in PC are efficient. A proposal for smoking intervention in PC from an effective cost perspective could be an BI for smokers and an II on those who find more difficult to leave the habit. 2011 Elsevier Espana, S.L. Todos los derechos reservados