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      Morbilidad, mortalidad y costes sanitarios evitables mediante una estrategia de tratamiento del tabaquismo en España Translated title: The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs

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          Abstract

          Objetivo: Se valoran los efectos que tendría una intervención destinada a reducir el uso de tabaco en la población española de fumadores sobre la morbilidad, la mortalidad y los costes asociados al consumo de tabaco. Método: Se ha adaptado el modelo Health and Economic Consequences of Smoking patrocinado por la OMS y desarrollado por The Lewin Group. La intervención propuesta incluye el acceso a asistencia farmacológica de un 35% de los fumadores que intentan dejar de fumar, y obtienen una tasa global de cesación al año del 7,2%. Las enfermedades estudiadas son: cáncer de pulmón, enfermedad coronaria, enfermedad cerebrovascular, EPOC, asma y bajo peso al nacer. Se estiman los casos de enfermedad y muerte atribuibles al consumo de tabaco evitados y la reducción en el coste sanitario debidos a la intervención, proyectados a 20 años. Resultados: Sin intervención, en el año 1 del modelo 2.136.094 fumadores padecen alguna de las condiciones clínicas atribuibles al consumo de tabaco, el coste asistencial es de 4.286 millones de euros y las muertes atribuibles son 26.537. La intervención propuesta evita 2.613, 9.192, 17.415 y 23.837 casos de enfermedad atribuible al consumo de tabaco en los años 2, 5, 10 y 20 del modelo, respectivamente. Los costes asistenciales acumulados evitados son 3,5 millones de euros en el año 2 y 386 millones de euros a los 20 años. Las muertes acumuladas evitadas son 284 en el año 2 y 9.205 a los 20 años de la intervención. La intervención añade un total de 78.173 años de vida al final del período considerado. Conclusiones: La disponibilidad de nuevas intervenciones eficaces en el tratamiento del tabaquismo y el incremento de la accesibilidad a las mismas pueden contribuir de forma relevante a la reducción de la morbilidad, la mortalidad y los costes sanitarios asociados al tabaquismo en España.

          Translated abstract

          Objective: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and healthcare costs. Methods: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed incluides pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in healthcare expenditure due to the intervention were estimated. Results: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; healthcare expenditure would be 4,286 million € and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated healthcare costs would amount to 3.5 million € at year 2 and 386 million € over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. Conclusions: The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and healthcare costs associated with smoking in Spain.

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          Diagnostic and statistical manual of mental disorders.

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            A descriptive model of the cigarette epidemic in developed countries

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              An analysis of the effectiveness of interventions intended to help people stop smoking.

              In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following personal advice and encouragement to stop smoking given by physicians during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P < .001) of all smokers stopped smoking and did not relapse up to 1 year as a direct consequence of the advice. The effect is modest but cost-effective: the cost of saving a life is about $1500. Supplementary interventions (follow-up letters or visits, demonstration of spirometry, etc) have an additional effect--variable in extent. Advice and encouragement are particularly effective for smokers at special risk--pregnant women (efficacy; 8%) and patients with ischemic heart disease. Behavior modification techniques (relaxation, rewards and punishment, avoiding "trigger" situations, etc), in group or individual sessions led by a psychologist, have an effect that is statistically significant (P = .05) but no greater than simple advice by a physician (2%); yet, these techniques are several times more expensive. The effect of hypnosis is unproved (no trials have used biochemical markers). Nicotine replacement therapy is effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouraged to use nicotine replacement therapy.
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                Author and article information

                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                August 2002
                : 16
                : 4
                : 308-317
                Affiliations
                [03] Barcelona orgnameUniversidad Pompeu Fabra orgdiv1Departament d'Economia i Empresa orgdiv2Centre de Recerca en Economia i Salut
                [05] Barcelona orgnameInstitut Català d'Oncologia orgdiv1Servei de Prevenció i Control del Cáncer
                [01] Madrid orgnameInstituto de Salud Carlos III orgdiv1Agencia de Evaluación de Tecnologías Sanitarias
                [04] orgnameGlaxoSmithKline orgdiv1Health Outcomes
                [02] orgnameCentro de Estudios sobre Promoción de la Salud
                Article
                S0213-91112002000400005 S0213-9111(02)01600400005
                10.1016/S0213-9111(02)71929-8
                12106550
                2511e84e-1426-4054-9afc-b0e751eedf96

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 28 December 2001
                : 10 April 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 60, Pages: 10
                Product

                SciELO Public Health

                Categories
                Originales

                Economic model,Prevention and control,Mortality,Smoking cessation policy,Smoking,Modelo económico,Prevención y control,Política asistencial,Mortalidad,Tabaquismo,Tabaco

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