금연치료제의 경제성 평가
Economic Evaluation of Varenicline and an Existing Smoking Cessation strategy in Korea
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초록
본 연구는 금연치료제인 varenicline과 bupropion의 경제성 분석을 수행하였다. 우리나라 30세~79세 성인 남녀 중 흡연자이면서 적극적인 금연 의지를 가지고 있는 사람들을 대상으로 varenicline과 bupropion의 금연성공률을 주요 효과 지표로 하여 마콥 모형을 적용하여 분석하였다. 마콥 상태는 금연, 재흡연, 흡연 및 사망으로 구분하였고 분석기간은 30년, 분석주기는 1년으로 설정하였다. 최종 효과 지표로 LYG(Life-Year Gained)와 QALY(Quality Adjusted Life Years)를 고려하였다. 보험자 관점을 가정하여 의료비용만을 포함하였으며 구체적으로 약품비용, 약국비용, 모니터링 비용, 흡연으로 인한 추가 의료비용을 추정하였다. 분석결과 varenicline은 bupropion에 비해 30,408 QALYs를 더 얻으면서 2,255억원을 더 지출하는 것으로 나타나 bupropion에 대한 varenicline의 점증적 비용-효용비(ICUR)는 7,415,712원/QALY로 추정되었다. 우리나라 1인당 GDP 수준을 고려할 때 금연치료제로서 varenicline은 다른 대안에 비해 비용-효과적인 것으로 판단할 수 있다. 민감도 분석 결과 할인율이 높아질수록, 분석기간이 짧을수록 점증적 비용-효용비가 높아지는 것으로 나타났으며 다른 요인에는 큰 영향을 받지 않은 것으로 나타났다.
Abstract
This study was conducted to estimate cost-effectiveness of varenicline, a pharmacotherapy developed to support smoking cessation, versus bupropion among prescription drugs. A 30-year Markov model with health states “Smoker”, “Quitter” and “Dead” was used for a hypothetical cohort of Korean smokers who are over 30 years old and willing to quit smoking. Utility values of smokers and quitters incorporated in the model were collected from Korea National Health & Nutrition Examination Survey. Transition probabilities were from clinical trials and Korean statistic data, and cost data were obtained from Korean health insurance reimbursement price list. The model used a 5% discount rate for costs and effectiveness. Sensitivity analyses were conducted on various parameters such as the time to reach mortality rate of ex-smokers compared to that of non-smokers, time horizon and discount rate. The incremental effectiveness of varenicline versus bupropion was 30,408 QALYs. The incremental cost of varenicline versus bupropion was 225 billion KRW. The ICER of varenicline comparing to bupropion was estimated at 7.4 million KRW per QALY. Sensitivity analyses were quite robust for all parameters but it was most sensitive to time horizon. Varenicline treatment for smoking cessation can be considered as cost-effective compared with existing therapies in Korea.
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