摘要：We compared the cost-effectiveness of a free nicotine replacement therapy (NRT) program with a statewide smoke-free workplace policy in Minnesota. We conducted 1-year simulations of costs and benefits. The number of individuals who quit smoking and the quality-adjusted life years (QALYs) were the measures of benefits. After 1 year, a NRT program generated 18 500 quitters at a cost of $7020 per quitter ($4440 per QALY), and a smoke-free workplace policy generated 10 400 quitters at a cost of $799 per quitter ($506 per QALY). Smoke-free work-place policies are about 9 times more cost-effective per new nonsmoker than free NRT programs are. Smoke-free workplace policies should be a public health funding priority, even when the primary goal is to promote individual smoking cessation. INDIVIDUAL SMOKING cessation is a highly cost-effective clinical medical intervention for individual smokers 1 ; nicotine replacement therapy (NRT) is a key element of this approach to combating nicotine addiction. 2 With the exception of telephone quit lines, 3 public health tobacco control programs have generally concentrated on population-based approaches, such as implementing policies that promote smoke-free workplaces. Smoke-free workplace policies not only provide an environment that encourages smokers to reduce or stop smoking but also protect nonsmokers from the toxins in environmental tobacco smoke. 4 , 5 The tobacco industry orchestrates opposition to smokefree workplaces 6 – 13 ; public health officials counteract with efforts to implement smoke-free policies. There is pressure on public health professionals to provide more tobacco control programs that are directed at individual smoking-cessation assistance. This tension was illustrated dramatically in Minnesota in 2002, when the attorney general sued the Minnesota Partnership for Action Against Tobacco (MPAAT), 12 , 14 a foundation that was created as part of the settlement of the state’s lawsuit against the tobacco industry. The attorney general alleged that MPAAT was ignoring its mandate to “offer smoking cessation opportunities to Minnesota smokers” 15 by encouraging clean indoor-air policies rather than providing individual treatment for smoking cessation. 9 As a result of this lawsuit, MPAAT scaled back its community-based environmental-change programs and replaced them with programs that focused on individual cessation. 12 , 14 In England, the entire tobacco control program funded by the Department of Health is supporting individual cessation rather than promoting environmental change, such as smoke-free workplaces. 16 – 18 While individual cessation programs–which should complement population-based tobacco control programs–are very cost-effective compared with other medical interventions, the question remains as to whether individual cessation programs are the best use of public health funds allocated for tobacco control programs. We compared the cost-effectiveness of a free NRT program versus a statewide smoke-free workplace campaign by examining the Minnesota case study because of its policy relevance. We assumed that a free NRT program provides only over-the-counter assistance, such as the nicotine patch and nicotine gum, and not other NRT or medications that require a prescription, such as bupropion. We found that a statewide smoke-free workplace policy was nearly 9 times more cost-effective per successful quitter generated than a free NRT program.
