心筋梗塞後の禁煙支援について

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2011年01月19日(Wed) 13:16

心筋梗塞で入院しても、喫煙者の70%が退院後、再喫煙してしまう。
再喫煙防止のための介入が必要であり、また有効である。
という論文です。

小児科医の立場から言えば、
とにかく「最初の1本」を吸わせない社会作りが、
なにより大事、ということになります。

Arch Intern Med. 2011 Jan 10;171(1):39-45.

Projected Cost-effectiveness of Smoking Cessation Interventions in Patients
Hospitalized With Myocardial Infarction.


Ladapo JA, Jaffer FA, Weinstein MC, Froelicher ES.

Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
 jladapo@post.harvard.edu.

Abstract

BACKGROUND: As many as 70% of smokers with acute myocardial infarction (AMI)
continue to smoke
after hospital discharge despite high rates of inpatient
smoking cessation counseling. Supportive contact after discharge improves
quit rates but is rarely used.

METHODS: Using data from a meta-analysis of randomized trials of smoking
cessation interventions and other published sources, we developed a Monte
Carlo model to project health and economic outcomes for a hypothetical US
cohort of 327 600 smokers hospitalized with AMI. We compared routine care,
consisting of advice to quit smoking, with counseling with supportive follow-up,
consisting of routine care and follow-up telephone calls from a nurse after
discharge. Primary outcomes were number of smokers, AMIs, and deaths averted;
health care and productivity costs; cost per quitter; and cost per quality-adjusted life-year.

RESULTS: Implementation of smoking cessation counseling with follow-up
contact for the 2010 cohort of hospitalized smokers would create 50 230
new quitters, cost $27.3 million in nurse wages and materials, and prevent
1380 nonfatal AMIs and 7860 deaths. During a 10-year period, it would
save $22.1 million in reduced hospitalizations but increase health care
costs by $166.4 million, primarily through increased longevity. Productivity
costs from premature death would fall by $1.99 billion and nonmedical expenditures
would increase by $928 million, for a net positive value to society of $894 million.
The program would cost $540 per quitter considering only intervention costs.
Cost-effectiveness would be $5050 per quality-adjusted life-year. Results were
sensitive to the utility and incidence of nonfatal AMI and the potential
effect of pharmacotherapies.

CONCLUSION: Smoking cessation counseling with supportive contact after discharge
is potentially cost-effective
and may reduce the incidence of smoking and its
associated adverse health events and social costs.

PMID: 21220659 [PubMed - in process]


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