Journal Information
Vol. 16. Issue 4.
Pages 308-317 (July - August 2002)
Vol. 16. Issue 4.
Pages 308-317 (July - August 2002)
Open Access
Morbilidad, mortalidad y costes sanitarios evitables mediante una estrategia de tratamiento del tabaquismo en España
(The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs)
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J. González-Enríqueza,
Corresponding author
jgonza@isciii.es

Correspondencia: Jesús González-Enríquez. Agencia de Evaluación de Tecnologías Sanitarias. Instituto de Salud Carlos III. Sinesio Delgado, s/n. 28029 Madrid.
, T. Salvador-Llivinab, A. López-Nicolásc, E. Antón de las Herasd, A. Musind, E. Fernándeze, M. Garcíae, A. Schiaffinoe, I. Pérez-Escolanod
a Agencia de Evaluación de Tecnologías Sanitarias. Instituto de Salud Carlos III. Madrid
b Centro de Estudios sobre Promoción de la Salud
c Universidad Pompeu Fabra. Departament d'Economia i Empresa. Centre de Recerca en Economia i Salut. Barcelona
d Health Outcomes HO. GlaxoSmithKline
e Institut Català d'Oncologia. Servei de Prevenció i Control del Cáncer. Barcelona
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Resumen
Objetivo

Se valoran los efectos que tendría una intervención destinada a reducir el uso de tabaco en la población española de fumadores sobre la morbilidad, la mortalidad y los costes asociados al consumo de tabaco.

Método

Se ha adaptado el modelo Health and Economic Consequences of Smoking patrocinado por la OMS y desarrollado por The Lewin Group. La intervención propuesta incluye el acceso a asistencia farmacológica de un 35% de los fumadores que intentan dejar de fumar, y obtienen una tasa global de cesación al año del 7,2%. Las enfermedades estudiadas son: cáncer de pulmón, enfermedad coronaria, enfermedad cerebrovascular, EPOC, asma y bajo peso al nacer. Se estiman los casos de enfermedad y muerte atribuibles al consumo de tabaco evitados y la reducción en el coste sanitario debidos a la intervención, proyectados a 20 años.

Resultados

Sin intervención, en el año 1 del modelo 2.136.094 fumadores padecen alguna de las condiciones clínicas atribuibles al consumo de tabaco, el coste asistencial es de 4.286 millones de euros y las muertes atribuibles son 26.537. La intervención propuesta evita 2.613, 9.192, 17.415 y 23.837 casos de enfermedad atribuible al consumo de tabaco en los años 2, 5, 10 y 20 del modelo, respectivamente. Los costes asistenciales acumulados evitados son 3,5 millones de euros en el año 2 y 386 millones de euros a los 20 años. Las muertes acumuladas evitadas son 284 en el año 2 y 9.205 a los 20 años de la intervención. La intervención añade un total de 78.173 años de vida al final del período considerado.

Conclusiones

La disponibilidad de nuevas intervenciones eficaces en el tratamiento del tabaquismo y el incremento de la accesibilidad a las mismas pueden contribuir de forma relevante a la reducción de la morbilidad, la mortalidad y los costes sanitarios asociados al tabaquismo en España.

Palabras clave:
Tabaco
Tabaquismo
Mortalidad
Política asistencial
Prevención y control
Modelo económico
Abstract
Objective

We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and healthcare costs.

Methods

We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed incluides pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking- related cases of disease and of averted death and the reduction in healthcare expenditure due to the intervention were estimated.

Results

Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; healthcare expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated healthcare costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered.

Conclusions

The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and healthcare costs associated with smoking in Spain.

Key words:
Smoking
Smoking cessation policy
Mortality
Prevention and control
Economic model
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Bibliogrífia
[1.]
US Department of Health and Human Services.
Reducing the health consequences of smoking. 25 years of progress. A report of the Surgeon General, 1989. Rokville: US DHHS, PHS, CDC, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,.
DHHS Publication N.° (CDC), (1989), pp. 89-8411
[2.]
R. Peto, A.D. López, J. Boreham, M. Thun, C. Heath.
Mortality from tobacco in developed countries: indirect estimation from national vital statistics.
Lancet, 339 (1992), pp. 1268-1278
[3.]
R. Peto, Z.M. Chen, J. Boreham.
Tobacco: the growing epidemic.
Nat Med, 5 (1999), pp. 15-17
[4.]
C.J. Murray, A. López.
Global mortality, disability and the contribution of risk factors: Global Burden of Disease Study.
Lancet, 349 (1997), pp. 1436-1442
[5.]
A.D. López, E.N. Collishaw, T. Piha.
A descriptive model of the cigarette epidemic in developed countries.
Tob Control, 3 (1994), pp. 242-247
[6.]
J.M. Borrás, E. Fernández, A. Schiaffino, C. Borrell, C. La Vecchia.
Pattern of smoking initiation in Catalonia (Spain) from 1948 to 1992.
Am J Public Health, 90 (2000), pp. 1459-1462
[7.]
R. Rodríguez Tapioles, A. Pueyos Sánchez, A. Bueno Cabanillas, M. Delgado Rodríguez, R. Gálvez Vargas.
Proporción de enfermedad atribuible al tabaco en la provincia de Granada.
Med Clin (Barc), 102 (1994), pp. 571-574
[8.]
R. Rodríguez Tapioles, A. Bueno Cabanillas, A. Pueyos Sánchez, M. Espigares García, M.A. Martínez González, R. Gálvez Vargas.
Morbilidad, mortalidad y años potenciales de vida perdidos atribuibles al tabaco.
Med Clin (Barc), 108 (1997), pp. 121-127
[9.]
J. González-Enríquez, F. Villar-Álvarez, J.R. Banegas-Banegas, F. Rodríguez-Artalejo, J.M. Martín-Moreno.
Tendencia de la mortalidad atribuible al tabaquismo en España. 1978-1992: 600.000 muertes en 15 años.
Med Clin (Barc), 109 (1997), pp. 577-582
[10.]
F. Rodríguez Artalejo, R. Hernández Vecino, A. Graciani, J.R. Banegas, J. Rey Calero.
La contribución del tabaco y otros hábitos de vida a la mortalidad por cáncer de pulmón en España de 1940 a 1988.
Gac Sanit, 8 (1994), pp. 272-279
[11.]
J.R. Banegas Banegas, F. Rodríguez Artalejo, J.M. Martin Moreno, J. González Enríquez, F. Villar Álvarez, A. Guasch Aguilar.
Proyección del impacto del hábito tabáquico sobre la salud de la población española y de los beneficios potenciales de su control.
Med Clin (Barc), 101 (1993), pp. 644-649
[12.]
B. Gónzález, P. Barber, E. Rodríguez.
El tabaco: ¿un caso de externalidades financieras en España?.
Anáisis económico de los estilos de vida: externalidades y coste social,
[13.]
J. Rovira, M. Escribano.
Estimación del impacto económico a largo plazo de una reducción del consumo de tabaco.
[14.]
US Department of Health and Human Services.
The health benefits of smoking cessation.
A report from the Surgeon General, DHHS publication N. ° (CDC), (1990), pp. 90-8416
[15.]
US Department of Health and Human Services.
The health consequences of smoking: nicotine addiction: A report from the Surgeon General.
Washington DC: Government Printing Office, DHHS Publication N. ° (CDC), (1988), pp. 88-8406
[16.]
American Psychiatric Association.
Diagnostic and statistical Manual of Mental Disorders.
4th,
[17.]
Royal College of Physicians.
Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians.
London: Royal College of Physicians,, (2000),
[18.]
C. Silagy, D. Mant, G. Fowler, T. Lancaster.
Nicotine replacement therapy for smoking cessation. The Cochrane Library Issue 2.
[19.]
R. West, A. McNeill, M. Raw.
Smoking cessation guidelines for health professionals: an update.
Thorax, 55 (2000), pp. 987-999
[20.]
US Department of Health and Human Services.
Treating tobacco use and dependence. Public Health Service.
Washington DC: Government Printing Office,, (2000),
[21.]
D.E. Jorenby, S.J. Leischow, M.A. Nides, S.I. Rennard, J.A. Johnston, A.R. Hughes, et al.
A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation.
N Engl J Med, 340 (1999), pp. 685-691
[22.]
M. Raw, A. McNeill, R. West.
Smoking cessation guidelines for health proffesionals. A guide to effective smoking cessation intervention for the health care system.
Thorax, 53 (1998), pp. 1-19
[23.]
M. Raw, A. McNeill, R. West.
Smoking cessation: evidence based recommendations for the health care system.
BMJ, 318 (1999), pp. 182-185
[24.]
M. Law, J.L. Tang.
An analysis of the effectiveness of interventions intended to help people stop smoking.
Arch Intern Med, 155 (1995), pp. 1933-1941
[25.]
M.C. Fiore, S. Smith, D. Jorenby, T. Baker.
The effectiveness of the nicotine patch for smoking cessation. A meta-analysis.
JAMA, 271 (1994), pp. 1940-1947
[26.]
R. Akehurst, J. Piercy.
Cost-effectiveness of the use of Nicorette nasal spray to assist quitting smoking among heavy smokers.
Br J Med Econ, 7 (1994), pp. 155-184
[27.]
S. Parrott, C. Godfrey, M. Raw, R. West, A. McNeill.
Guidance for commissioners on the cost effectiveness of smoking cessation interventions.
Thorax, 53 (1998), pp. 4-24
[28.]
Health and Economic Consequences of Smoking Model (Version 2.2.2). World Health Organization [consultado 22/08/2000]. Disponible en: http://www.who.dk/adt/ecos/whoweb.asp.
[29.]
M.E. Orme, S.L. Hogue, L.M. Kennedy, A.C. Paine, C. Godfrey.
Development of the Health and Economic Consequences of Smoking Interactive Model.
Tob Control, 10 (2001), pp. 55-61
[30.]
M.J. Thun, L.F. Apicella, S.J. Henley.
Smoking vs other risk factors as the cause of smoking-attributable deaths. Confounding in the courtroom.
JAMA, 284 (2000), pp. 706-712
[31.]
Anónimo..
Cigarette smoking-attributable mortality and years of potential life lost..
United States, 1990. MMWR, 42 (1993), pp. 645-649
[32.]
Instituto Nacional de Estadística (INE).
Revisión del Padrón Municipal.
Datos de ámbito nacional, comunidad autónoma y provincia., (1998),
[33.]
Ministerio de Sanidad y Consumo.
Encuesta Nacional de Salud 1997..
[34.]
Generalitat de Catalunya.
Departament de Sanitat i Seguretat Social. Enquesta de Salut de Catalunya (ESCA).
[35.]
J.R. Hughes, S.B. Gulliver, J.W. Fenwick, W.A. Valliere, K. Cruser, S. Pepper, et al.
Smoking cessation among self-quitters.
Health Psychol, 11 (1992), pp. 331-334
[36.]
J. Cromwell, W.J. Bartosch, M.C. Fiore, V. Hasselblad, T. Baker.
Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research.
JAMA, 278 (1997), pp. 1759-1766
[37.]
V. Sobradillo, M. Miravitlles, C.A. Jiménez.
Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo.
Arch Bronconeumol, 35 (1999), pp. 159-166
[38.]
J. Cosín, E. Asín, J. Marrugat, R. Elosua, F. Arós, M. De los Reyes, et al.
for the PANES Study group. Prevalence of angina pectoris in Spain.
Eur J Epidemiol, 15 (1999), pp. 23-330
[39.]
British Heart Foundation Statistics.
Coronary Heart Diseases Statistics. Database, 1998.
[40.]
M. Caicoya, T. Rodríguez, C. Lasheras, R. Cuello, C. Corrales, B. Blázquez.
Incidencia del accidente cerebrovascular en Asturias: 1990-1991.
Rev Neurol (Barc), 24 (1996), pp. 806-811
[41.]
D.M. Parkin, S.L. Whelan, J. Ferlay, L. Raymond, L. Joung.
Incident Cancer in Five continents.
[42.]
International Agency for Research on Cancer.
EUCAN.
Cancer Incidence, Mortality and Prevalence in the European Union., (1996),
[43.]
Instituto Nacional de Estadística (INE).
Movimiento Natural de la Población.
Tomo I. INEbase, 2000, (1998),
[44.]
Instituto Nacional de Estadística, INE..
Defunciones según la causa de Muerte 1997. Resultados por CCAA..
[45.]
Banco Central Europeo.
Boletín Mensual del BCE 2000..
[46.]
J. Morera, J. Sunyer, J. Antó, J. Murillo, M. Sáez.
Costes sociales y económicos de la EPOC. Libro de ponencias y comunicaciones libres del III Symposium sobre Enfermedad Pulmonar Obstructiva Crónica. Badalona: Servicio de Neumología.
Hospital Universitario Germans Trias i Pujol, de febrero de, (1992), pp. 6-7
[47.]
V. Plaza, J. Serra-Batlles, M. Ferrer, E. Morejon.
Quality of Life and Economic Features in Elderly Asthmatics.
Respiration, 67 (2000), pp. 65-70
[48.]
P. Plans-Rubio.
Cost-effectiveness analysis of treatments to reduce cholesterol levels, blood pressure and smoking for the prevention of coronary heart disease.
Pharmacoeconomics, 13 (1998), pp. 620-643
[49.]
F. Carod-Artal, J. Egido, G. González, E. Varela.
Direct cost of cerebrovascular disease during the first year of follow u.p..
Rev Neurol, 1 (1999), pp. 123-130
[50.]
J. Wolstenholme, D. Whynes.
The Hospital Costs of Treating Lung Cancer in the U.K..
Br J Cancer, 80 (1999), pp. 215-218
[51.]
E. Lewit, L. Baker, H. Corman, P. Shiono.
The Direct Cost of Low Birth Weight.
Future Child, 5 (1995), pp. 35-56
[52.]
Adis International.
Medimecum. Guía de terapia farmacológica.
Madrid: Adis International,, (1999),
[53.]
Consejo General de Colegios Oficiales de Farmacéuticos..
Catálogo de Especialidades Farmacéuticas..
[54.]
Instituto Nacional de Estadística (INE).
Encuesta de Estructura Salarial..
[55.]
C. Callum.
The UK smoking epidemic: deaths in 1995.
[56.]
Evironmental Protection Agency.
Respiratory health effects of passive smoking: lung cancer and other diseases.
Washington DC: Evironmental Protection Agency, Office of Research and Development,, (1992),
[57.]
E. Fernández, J.R. González, J.M. Borrás, V. Sánchez, V. Moreno, M. Peris.
Evolución de la mortalidad por cáncer en Cataluña (1975-1998).
Med Clin (Barc), 116 (2001), pp. 605-609
[58.]
J.M. Shultz, T.E. Novotny, D.P. Rice.
Quantifying the disease impact of cigarette smoking with SAMMEC II software.
Public Health Rep, 106 (1991), pp. 326-333
[59.]
L.S. Miller, X. Zhang, T. Novotny, D.P. Rice, W. Max.
State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993.
Public Health Rep, 113 (1998), pp. 140-151
[60.]
L.S. Miller, X. Zhang, D.P. Rice, W. Max.
State estimates of total medical expenditures attributable to cigarette smoking, 1993.
Public Health Rep, 113 (1998), pp. 447-458
[61.]
L.S. Miller.
Smoking estimate correction.
Public Health Rep, 113 (1998), pp. 191
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