Clinical efficacy observation and cost-effectiveness ratio analysis of acupuncture plus auricular point pressing for quitting tobacco addiction

This thesis consists of two parts: a literature review and a clinical study. Literature review. Review 1: from the perspective of traditional Chinese medicine (TCM), it mainly describes the understanding in ancient TCM literature of the disease name, etiology and pathogenesis of tobacco addiction, as well as syndrome differentiation and clinical treatment; from the perspective of Western medicine, it discusses the causative factors of tobacco addiction and Western treatment methods and diagnostic criteria. Review 2: it introduces the application and research of health economics in the field of acupuncture treatment. Clinical study. Objective: on the basis of previous large-sample observations of the efficacy of acupuncture for smoking cessation, to carry out a randomized controlled study of an acupuncture smoking-cessation protocol, comparing the smoking-cessation efficacy of acupuncture plus auricular seed-pressing and nicotine patch replacement therapy in nicotine-dependent individuals, and to evaluate the benefit of the acupuncture protocol from a health-economics perspective. Methods: 1. Clinical efficacy evaluation: 60 eligible patients were randomly divided into two groups of 30 each, an acupuncture plus auricular seed-pressing group and a nicotine patch group. Smoking cessation rate, the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) were used as outcome measures, observed at weeks 1, 2, 4 and 8 after treatment, and clinical efficacy was evaluated by smoking cessation rate, FTND and HSI. 2. Health-economic evaluation: according to "Methods for Pharmacoeconomic Evaluation", smoking cessation rate, FTND and HSI were taken as outcome indicators and compared with costs, and a cost-effectiveness analysis was performed. Results: 1. Clinical efficacy: the two groups were comparable at baseline. After 8 weeks of treatment, FTND and HSI scores decreased markedly in both groups, with a significant time effect (P<0.01). The pre-post differences in FTND and HSI scores were statistically significant in both groups (P<0.01), but the differences between groups at each assessment time point were not statistically significant (P>0.05). Point smoking cessation rates at weeks 1, 2, 4 and 8 increased in both groups after treatment, with no statistically significant differences between groups at any time point (P>0.05). 2. Health-economic evaluation: (1) Cost analysis: after 8 weeks of treatment, the total costs were 1867.3 yuan and 2204.4 yuan in the two groups, respectively, a statistically significant difference (P<0.01). Since the clinical efficacy evaluation showed no statistically significant difference between groups, the conditions for cost-minimization analysis (CMA) were met; the CMA indicated that, for the same clinical efficacy, group A had the lower cost. (2) Cost-effectiveness analysis: the cost per FTND point was 384.09 and 522.37 yuan in groups A and B, respectively; per HSI point, 482.49 and 699.97 yuan; and per 1% of smoking cessation rate, 50.59 and 49.00 yuan. Overall, to achieve the same therapeutic effect, the average unit cost was lower in group A. Conclusion: both acupuncture plus auricular seed-pressing and nicotine patches can effectively reduce nicotine dependence, improve scores and raise smoking cessation rates, with comparable efficacy in reducing the degree of nicotine dependence. This study shows that acupuncture plus auricular seed-pressing costs less than nicotine patch therapy; it can be inferred that among protocols with similar efficacy the CMA and CEA results are consistent. Acupuncture plus auricular seed-pressing has a smaller cost-effectiveness ratio than nicotine patch therapy.