Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months' follow-up.

BACKGROUND: This study evaluated the cost-effectiveness of an intervention based on a training course for community pharmacists and a smoking cessation service (CESAR©), using limited societal and the health provider perspectives. METHODS: Non-randomized controlled trial of 12-months' follow-up. Spanish community pharmacists who were previously trained with CESAR© formed the intervention group (n = 102), and control group delivered usual care (n = 80). CESAR Patients were smokers identified by the community pharmacists when they attended the pharmacy. Data were self-reported. Outcomes were smoking cessation and quality-of-life (EQ-5D-3L) and were collected at baseline, 6, and 12 months. Costs data included direct health costs, work loss, and intervention costs. Smoking cessation was analyzed through logistic regression models. Generalized linear models were carried out for quality-adjusted life year (QALY) and costs. Incremental cost-effectiveness ratio (ICER) and cost-utility ratio (ICUR) were calculated. RESULTS: In total, 800 smoking patients were included in the intervention group and 278 in the control group. Of these, 487 and 151 patients completed the study, respectively. Costs were lower in the intervention group compared to the control group in both perspectives. At 12 months, 54.3% and 37.1% patients from the intervention and the control groups reported smoking cessation, respectively. The difference in probability of cessation in the intervention compared to the control group was 17.6% (CI:0.05; 0.25). The mean QALY was higher in the intervention group [0.03(CI: 0.01; 0.07)]. The ICER and the ICUR were dominant for the intervention group. CONCLUSION: This intervention for smoking cessation showed that the CESAR© intervention, that combined a training for community pharmacists with a smoking cessation service was efficient for smoking cessation and QALY at 12 months' follow-up. TRIAL REGISTRATION: NCT05461066, retrospectively registered (July 15, 2022).

Impacto del servicio profesional farmacéutico asistencial de cesación tabáquica en la farmacia comunitaria. Protocolo del estudio y características de los investigadores y los pacientes / Impact of the professional pharmaceutical care service for smoking cessation in community pharmacies. Study protocol and characteristics of researchers and patients

Introducción:  el tabaquismo es un grave problema de salud pública, el 23 % de los españoles mayores de 15 años fuma a diario y el 2,4 % es fumador ocasional. El farmacéutico comunitario (FC) es un profesional sanitario accesible y cercano a la población que puede desempeñar una importante labor en cesación tabáquica. Es fundamental realizar estudios de investigación que demuestren el impacto de la intervención del FC en tabaquismo y ayuden a definir un protocolo de actuación que pueda implantarse de manera generalizada en cualquier farmacia comunitaria de nuestro país.Material y métodos:  el protocolo se utilizó en un estudio prospectivo controlado no aleatorizado de 12 meses de seguimiento en paciente fumador mayor de 18 años que acudía a la farmacia comunitaria con una prescripción médica para dejar de fumar, haciendo una consulta para dejar de fumar o paciente que se detecta como fumador. El estudio se diseñó para desarrollarse en 100 farmacias con farmacéuticos capacitados a través del programa CESAR (grupo intervención) que realizaban una intervención estructurada y 100 farmacias con farmacéuticos no capacitados (grupo control) que realizaban una intervención habitual. Cada una de las farmacias debía reclutar un total de 5 pacientes, lo que supondría un total de 1.000 casos.Resultados:  en el estudio participaron 182 FC (grupo intervención: 102, grupo control: 80), la mayoría de los cuales desarrollaban su actividad profesional en farmacias de barrio. Se incorporaron 1.078 pacientes (grupo intervención: 800, grupo control: 278), con una distribución homogénea por sexos y una edad media de 49 años.