Custo-efetividade do uso de uma ferramenta eletrônica na abordagem ao tabagismo

Abstract

Even with all the efforts to draw up evidence-based guidelines and ratify effective approaches, the engagement smokers with anti-smoking treatment represents a significant obstacle in smoking cessation course. The use of decision aid tools to inform users about the therapeutic options available and to make an informed decision could impact public health. E-healths, such as the “Pare de Fumar Conosco” software can be effective in smoking. In view of limited resources, when assessing the technology implementantion, it is substantial that, in addition to effectiveness, costeffectiveness is also determined. Through a randomized clinical trial, study's objective was to evaluate the effectiveness of this electronic tool, as well as its costeffectiveness, compared to the basic approach, which follows the National Cancer Institute standards (INCA). A total of 243 participants were recruited and randomized into two treatment arms. After interventions submitting (software and basic approach), an invitation was made for somkers to join the conventional smoking treatment, made available for 12 weeks by an anti-smoking pole. Primary outcome, informed decisionmaking, and secondary (motivation level, smoking cessation, adherence and treatment completion) were measured during follow-up. Based on these inferences, the probabilities that made up the economic model were estimated, carried out from the service provider and the Unified Health System (SUS) perspectives, with a time horizon of one year. Benefits measures were informed decision-making and smoking cessation. Technologies costs involved and of the anti-smoking pole were measured by primary and secondary sources. Incremental cost-effectiveness ratio (ICER), deterministic and Monte Carlo probabilistic sensitivity analyzes (1000 interactions) were performed. No willingness to pay threshold was adopted. Informed decisionmaking and treatment completion were superior in the software, in the order of 31% and 20%, respectively. In both groups, the motivation level was high (≥ 95%). Still with the decrease inherent to the smoking population, adherence was favorable to the electronic tool, while smoking cessation to the control group. After adjusting for confounding factors, an incidence ratio for decision-making of 2.2 (CI95% - 1.06-4.63) was found for the intervention group. In the economic assessment, the ICER of all base cases was dominant dominante (R$ - 2.585.178, 29 a R$ - 325.001,20). The software showed a lower cost and greater effectiveness compared to the standard INCA strategy. Aspects with the greatest impact in ICER decreasing were the software cost reduction and the increase of basic approach cost. In all probabilistic analyzes, the percentage of interactions was the majority in the quadrant of the cost-effectiveness plan, referring to the lowest cost and greatest effectiveness (53.6% to 82.5%). The present study indicated that the electronic tool is clinically effective and cost-saving in relation to the basic approach.