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Cochrane Database of Systematic Reviews

タバコ依存症治療を促進する医療費助成制度

Información

DOI:
https://doi.org/10.1002/14651858.CD004305.pub5Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 12 septiembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Tabaquismo

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Floor A van den Brand

    Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands

  • Gera E Nagelhout

    Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands

    IVO Addiction Research Institute, Rotterdam, Netherlands

    Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands

  • Ayalu A Reda

    Department of Biostatistics, School of Public Health, Brown University, Providence, USA

    Department of Sociology, Brown University, Providence, USA

    Population Studies and Training Centre, Brown University, Providence, USA

  • Bjorn Winkens

    Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands

  • Silvia M A A Evers

    Department of Health Services Research, Maastricht University (CAPHRI), Maastricht, Netherlands

  • Daniel Kotz

    Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands

    Institute of General Practice, Addiction Research and Clinical Epidemiology, Medical Faculty, Heinrich‐Heine‐University, Düsseldorf, Germany

  • Onno CP van Schayck

    Correspondencia a: Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands

    [email protected]

Contributions of authors

For the current update, FB, GN and AAR selected studies. FB and GN assessed the quality of the included studies and extracted data. DK served as referee in study inclusion. FB conducted the analysis and wrote the update. BW checked the analyses. SE was in charge of study selection, analysis and writing of cost‐effectiveness data. All authors critically commented on several drafts of the review. CPS had final responsibility and final check of the text.

Sources of support

Internal sources

  • Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands.

External sources

  • No sources of support supplied

Declarations of interest

FB: none known
GN: none known
AAR: none known
BW: none known
SE: none known
DK received an unrestricted grant from Pfizer in 2009 for an investigator‐initiated trial on the effectiveness of practice nurse counselling and varenicline for smoking cessation in primary care (Dutch Trial Register NTR3067)
CPS and the lead author of the first version of this review conducted one of the trials included in the review (Kaper 2006)

Acknowledgements

Janneke Kaper was lead author of the first version of this review and Hurmuz Fikretler was an author on the update in 2009.

We would like to thank Karen Slama and Tim Coleman for their constructive peer review comments, and Lindsay Stead for performing the literature search and for her support during the preparation of this review. We also would like to thank the following authors who provided us with additional information regarding their studies: Raymond Boyle, Sue Curry, Paola Dey, John Hughes, Diane Ives, Judith Lave, Sara McMenamin, Vardhamam Patel and Joachim Roski.

Version history

Published

Title

Stage

Authors

Version

2017 Sep 12

Healthcare financing systems for increasing the use of tobacco dependence treatment

Review

Floor A van den Brand, Gera E Nagelhout, Ayalu A Reda, Bjorn Winkens, Silvia M A A Evers, Daniel Kotz, Onno CP van Schayck

https://doi.org/10.1002/14651858.CD004305.pub5

2012 Jun 13

Healthcare financing systems for increasing the use of tobacco dependence treatment

Review

Ayalu A Reda, Daniel Kotz, Silvia M A A Evers, Constant Paul van Schayck

https://doi.org/10.1002/14651858.CD004305.pub4

2009 Apr 15

Healthcare financing systems for increasing the use of tobacco dependence treatment

Review

Ayalu A Reda, Janneke Kaper, Hurmuz Fikretler, Johan L Severens, Constant Paul van Schayck

https://doi.org/10.1002/14651858.CD004305.pub3

2005 Jan 24

Healthcare financing systems for increasing the use of tobacco dependence treatment

Review

Janneke Kaper, Edwin Wagena, J L Severens, Onno (Constant Paul) van Schayck

https://doi.org/10.1002/14651858.CD004305.pub2

2003 Jul 21

Health care financing systems for increasing utilisation of tobacco dependence treatment

Protocol

Janneke Kaper, Edwin E. J. Wagena, Onno C.P. Van Schayck

https://doi.org/10.1002/14651858.CD004305

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Prisma study flow diagram of studies included in most recent update of this review
Figuras y tablas -
Figure 2

Prisma study flow diagram of studies included in most recent update of this review

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 1 Full versus no financial coverage.
Figuras y tablas -
Analysis 1.1

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 1 Full versus no financial coverage.

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 2 Full versus partial financial coverage.
Figuras y tablas -
Analysis 1.2

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 2 Full versus partial financial coverage.

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 3 Partial versus no financial coverage.
Figuras y tablas -
Analysis 1.3

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 3 Partial versus no financial coverage.

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 4 Partial versus another partial coverage (at least 6 months CA).
Figuras y tablas -
Analysis 1.4

Comparison 1 Interventions directed at individuals: abstinence from smoking, Outcome 4 Partial versus another partial coverage (at least 6 months CA).

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 1 Full versus no financial coverage.
Figuras y tablas -
Analysis 2.1

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 1 Full versus no financial coverage.

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 2 Full versus partial financial coverage.
Figuras y tablas -
Analysis 2.2

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 2 Full versus partial financial coverage.

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 3 Partial versus no financial coverage.
Figuras y tablas -
Analysis 2.3

Comparison 2 Interventions directed at individuals: number of participants making a quit attempt for at least 24 h, Outcome 3 Partial versus no financial coverage.

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 1 Full versus no financial coverage.
Figuras y tablas -
Analysis 3.1

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 1 Full versus no financial coverage.

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 2 Full versus partial financial coverage.
Figuras y tablas -
Analysis 3.2

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 2 Full versus partial financial coverage.

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 3 Partial versus no financial coverage.
Figuras y tablas -
Analysis 3.3

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 3 Partial versus no financial coverage.

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 4 Partial versus partial financial coverage.
Figuras y tablas -
Analysis 3.4

Comparison 3 Interventions directed at individuals: use of smoking cessation treatment, Outcome 4 Partial versus partial financial coverage.

Comparison 4 Interventions directed at healthcare providers, Outcome 1 Abstinence from smoking.
Figuras y tablas -
Analysis 4.1

Comparison 4 Interventions directed at healthcare providers, Outcome 1 Abstinence from smoking.

Comparison 4 Interventions directed at healthcare providers, Outcome 2 Use of nicotine replacement therapy and/or bupropion.
Figuras y tablas -
Analysis 4.2

Comparison 4 Interventions directed at healthcare providers, Outcome 2 Use of nicotine replacement therapy and/or bupropion.

Comparison 4 Interventions directed at healthcare providers, Outcome 3 Use of behavioural interventions.
Figuras y tablas -
Analysis 4.3

Comparison 4 Interventions directed at healthcare providers, Outcome 3 Use of behavioural interventions.

Summary of findings for the main comparison. Interventions directed at individuals: full financial coverage compared to no financial coverage for increasing abstinence from smoking

Interventions directed at individuals: full financial coverage compared to no financial coverage for increasing abstinence from smoking

Patient or population: smokers
Setting: medical practises, companies, members of a health insurance company, outpatient respirology clinic
Intervention: full financial coverage for abstinence from smoking
Comparison: no coverage

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no coverage

Risk with full financial coverage

Abstinence from smoking

Study population

RR 1.77
(1.37 to 2.28)

9333
(6 RCTs)

⊕⊕⊕⊝
Moderate1,2

84 per 1000

149 per 1000
(115 to 192)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Downgraded one level because of risk of bias: all studies except for Hughes 1991 had a serious risk of bias.
2We rated Hughes 1991 and Twardella 2007 serious for imprecision, and Pakhale 2015 very serious for imprecision, however, we did not downgrade the evidence because these studies were small and had a minor effect on the outcome.

Figuras y tablas -
Summary of findings for the main comparison. Interventions directed at individuals: full financial coverage compared to no financial coverage for increasing abstinence from smoking
Summary of findings 2. Interventions directed at healthcare providers compared to placebo for increasing the use of smoking cessation treatment

Interventions directed at healthcare providers compared to no interventions for increasing the use of smoking cessation treatment

Patient or population: physicians and clinics from a multispecialty group practice
Setting: health clinics in the USA and group practices in Germany
Intervention: financial interventions directed at healthcare providers (pay for performance and direct payment)
Comparison: no financial intervention

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no interventions

Risk with interventions directed at healthcare providers

Abstinence from smoking

Study population

RR 1.16
(0.98 to 1.37)

2311
(2 RCTs)

⊕⊕⊕⊝
Moderate1

181 per 1000

209 per 1000
(177 to 247)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Downgraded one level because both studies were judged to be at serious risk of bias.

Figuras y tablas -
Summary of findings 2. Interventions directed at healthcare providers compared to placebo for increasing the use of smoking cessation treatment
Comparison 1. Interventions directed at individuals: abstinence from smoking

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full versus no financial coverage Show forest plot

6

9333

Risk Ratio (M‐H, Random, 95% CI)

1.77 [1.37, 2.28]

1.1 Continuous abstinence (at least 6 months)

2

1486

Risk Ratio (M‐H, Random, 95% CI)

4.38 [1.94, 9.87]

1.2 Point prevalence abstinence

4

7847

Risk Ratio (M‐H, Random, 95% CI)

1.64 [1.45, 1.86]

2 Full versus partial financial coverage Show forest plot

5

5914

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.71, 1.48]

2.1 Continuous abstinence (at least 6 months)

1

28

Risk Ratio (M‐H, Random, 95% CI)

2.17 [0.50, 9.35]

2.2 Point prevalence abstinence

4

5886

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.67, 1.44]

3 Partial versus no financial coverage Show forest plot

5

7108

Risk Ratio (M‐H, Random, 95% CI)

1.27 [1.02, 1.59]

3.1 Continuous abstinence (at least 6 months)

2

3707

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.81, 1.45]

3.2 Point prevalence

3

3401

Risk Ratio (M‐H, Random, 95% CI)

1.49 [0.98, 2.24]

4 Partial versus another partial coverage (at least 6 months CA) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. Interventions directed at individuals: abstinence from smoking
Comparison 2. Interventions directed at individuals: number of participants making a quit attempt for at least 24 h

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full versus no financial coverage Show forest plot

4

9065

Risk Ratio (M‐H, Random, 95% CI)

1.11 [1.04, 1.17]

2 Full versus partial financial coverage Show forest plot

4

5486

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.84, 1.17]

3 Partial versus no financial coverage Show forest plot

5

6944

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.98, 1.31]

Figuras y tablas -
Comparison 2. Interventions directed at individuals: number of participants making a quit attempt for at least 24 h
Comparison 3. Interventions directed at individuals: use of smoking cessation treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Full versus no financial coverage Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Nicotine replacement therapy

7

9455

Risk Ratio (M‐H, Random, 95% CI)

1.79 [1.54, 2.09]

1.2 Bupropion

3

6321

Risk Ratio (M‐H, Random, 95% CI)

3.22 [1.41, 7.34]

1.3 Behavioural interventions

4

9215

Risk Ratio (M‐H, Random, 95% CI)

1.77 [1.19, 2.65]

1.4 Pharmacotherapy, not specified

1

48

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.73, 1.68]

2 Full versus partial financial coverage Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Nicotine replacement therapy

4

22380

Risk Ratio (M‐H, Random, 95% CI)

1.76 [1.27, 2.43]

2.2 Bupropion

2

3700

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.84, 2.41]

2.3 Behavioural interventions

1

16922

Risk Ratio (M‐H, Random, 95% CI)

3.95 [3.15, 4.95]

2.4 Pharmacotherapy, not specified

1

28

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.70, 2.02]

3 Partial versus no financial coverage Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Nicotine replacement therapy

5

6944

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.99, 1.91]

3.2 Bupropion

3

6765

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.03, 1.29]

3.3 Varenicline

1

1380

Risk Ratio (M‐H, Random, 95% CI)

1.85 [1.68, 2.03]

3.4 Behavioural interventions

1

104

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.22, 2.71]

4 Partial versus partial financial coverage Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 Nicotine replacement therapy

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Behavioural interventions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 3. Interventions directed at individuals: use of smoking cessation treatment
Comparison 4. Interventions directed at healthcare providers

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abstinence from smoking Show forest plot

2

2311

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.98, 1.37]

1.1 Continuous abstinence (at least 6 months)

1

222

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.10, 11.30]

1.2 Point prevalence

1

2089

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.98, 1.37]

2 Use of nicotine replacement therapy and/or bupropion Show forest plot

2

2311

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.76, 1.18]

3 Use of behavioural interventions Show forest plot

3

25820

Risk Ratio (M‐H, Random, 95% CI)

1.69 [1.01, 2.86]

Figuras y tablas -
Comparison 4. Interventions directed at healthcare providers