Background: Chronic Obstructive Pulmonary Disease (COPD) poses a substantial
burden to Hong Kong. Smoking is the single most important risk factor for COPD.
Intensive smoking cessation in COPD patients slows disease progression. Community
pharmacy based smoking cessation in healthy smokers could forestall COPD onset. Each
of these programs has been proven effective and cost-effective worldwide. Currently
there are smoking cessation clinics in Hong Kong. But community pharmacy-based
smoking cessation services are not available. The present study firstly attempts to identify
the disease burden of COPD; secondly, to investigate if community pharmacy-based
smoking cessation services are applicable in Hong Kong; finally, to examine if
establishing the services would be cost effective in reducing the burden of COPD.
Methods: A series of data analysis of mortality, morbidity and cost of hospitalization
(length of stay × standard daily ward cost) was conducted to understand the burden of
COPD in Hong Kong. Cost effectiveness analysis based on a Markov model evaluated smoking cessation strategies against usual care: (1) minimal counseling in smoking
cessation clinics (MiniC) for COPD patients; (2) intensive counseling with
pharmacotherapy in smoking cessation clinics (IC_pharm) for COPD patients; (3)
community pharmacist-assisted service (CPA) for healthy smokers; (4) combination of
CPA and MiniC (CPA+MiniC); (5) combination of CPA and IC_pharm
(CPA+IC_Pharm). The Markov model was constructed by sex, smoking status and
COPD severity to calculate the lifetime cost of COPD, cost of smoking cessation
programs and QALYs. Both effectiveness and cost were discounted at 3%. Incremental
cost effectiveness ratios (ICERs), i.e. cost per one QALY gain, served as the decision
making rule. One way sensitivity analysis, threshold analysis and probabilistic sensitivity
analysis were performed to explore the uncertainty around the parameters.
Results: The overall age adjusted mortality of COPD increased from 28.8 per 100 000 in
1981 to 30.14 per 100 000 in 2008. Numbers of people aged 65+ with known COPD was
projected to be over 100 000 by 2036. There were 3.8 and 7.8 years of life lost (YLL) and
3.6 and 5.6 QALYs lost due to COPD for male and female smokers respectively. Medical
costs of hospitalization were estimated to be over HK$ one billion (US$132 million) in 2008.
Seventy one COPD cases could be avoided in the simulated cohort by CPA. If the
threshold value was HK$247 332 for one QALY gain, CPA was more cost effective than
IC_Pharm, with an ICER of HK$47 717. CPA+MiniC dominated CPA. CPA+IC_Pharm was more cost effective than CPA+MiniC (ICER, HK$36 000). The
probability of CPA+ IC_pharm being the most cost effective strategy was approaching
0.8 if one QALY was worth HK$96 000, and it was associated with the maximum
expected QALYs if societal value for one QALY was no less than HK$80 000.
Conclusion: The model-based economic evaluation demonstrated that CPA+IC_Pharm
would be the most cost-effective smoking cessation strategy. Community pharmacy
based (CPA) smoking cessation services could be applicable and should be proposed in
Hong Kong to reduce the burden of smoking related diseases. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/174319 |
| Date | January 2011 |
| Creators | Chen, Jing, 陈静 |
| Contributors | Johnston, JM, McGhee, S |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B47157252 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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