Real-Life-Evaluation des Kompakt-Programmes zur Tabakentwöhnung

[Potential Savings in Treatment Costs of COPD through Smoking Cessation: Modeling for DMP COPD in Germany - Scientific Action Group on Tobacco Cessation (WAT) e. V.]

Basierend auf Real-life-Daten für die Stadien-Verteilung von COPD-Patienten (GOLD) und den faktischen Stadien-bezogenen Behandlungskosten innerhalb einer bundesweiten Kohortenstudie (COSYCONET) 1 wird modellhaft für das Szenario einer Reduktion der Raucher-Quote in dieser Patientengruppe von 26 % um 10 %-Punkte auf 16 % ermittelt, welchen Einfluss die reduzierte Raucher-Quote auf die Behandlungskosten haben dürfte. Zugrunde gelegt wird die Annahme, dass bei herabgesetzter Raucher-Quote leichtere Stadien (I/II) stärker repräsentiert sind, während sich höhere und kostenintensivere Stadien (III/IV) proportional verkleinern. Die Intervention zur Erreichung der Tabakabstinenz wird für die überschlägigen Modell-Berechnungen kalkuliert mit den typischen Kosten einer leitlinienkonformen Behandlung durch Nutzung eines verhaltenstherapeutischen Gruppen-Entwöhnungs-Programmes und der parallel eingesetzten medikamentösen Unterstützung 23 . Im Ergebnis zeigt sich die mögliche Absenkung der Fallkosten um 10,5 %, wobei reduzierte Kosten bei Komorbiditäten nicht berücksichtigt sind.

[COVID-19 and Smoking - A Position Paper by the DGP Taskforce for Smoking Cessation]

Tobacco smoking is associated with severe health risks. In 2020, the WHO estimated that 8 million people have died due to smoking. Furthermore, smoking tobacco is a well-known risk factor for various infectious pulmonary diseases. The question raised, whether smoking is facilitating SARS-CoV-2-infections and increases adverse outcomes of COVID-19. To answer these questions a narrative review was conducted, finally including 7 systematic reviews with meta-analyses published in January and February 2021. Tobacco smoking was associated with an increased COVID-19 disease severity (odds ratio range of active vs. never smokers 1.55-2.19 and former vs. never smokers 1.20-2.48) and an increased COVID-19 in-hospital mortality (odds ratio range of active vs. never smokers 1.35-1.51 and former vs. never smokers 1.26-2.58). Beside immediate pulmonary toxic effects through active smoking, the cumulative livelong tobacco exposition and subsequent tobacco-associated diseases seem to predominantly predict adverse outcomes in patients with COVID-19. Data regarding an increased risk of infection among smokers is conflicting. However, a large observational study from England with 2.4 million persons reported an association between tobacco smoking and typical symptoms of COVID-19. For e-cigarettes and vaping less data exist, but experimental and first clinical investigations also suggest an increased risk for adverse outcomes for their use and SARS-CoV-2 infections. Especially during the current SARS-CoV-2 pandemic with limited therapeutic options it is particularly important to advise smokers of their increased risks for unfavourable COVID-19 outcomes. Evidence based support for smoking cessation should be offered. In Germany, the existing and well-established methods to support tobacco cessation need to be reimbursed by statutory health insurances.