Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model.

Abstract

BACKGROUND:

Low-dose computed tomography (CT) screening can reduce lung cancer mortality in people at high risk; adding a smoking cessation intervention to screening could further improve screening program outcomes. This study aimed to assess the impact of adding a smoking cessation intervention to lung cancer screening on clinical outcomes, costs and cost-effectiveness.

METHODS:

Using the OncoSim-Lung mathematical microsimulation model, we compared the projected lifetime impact of a smoking cessation intervention (nicotine replacement therapy, varenicline and 12 wk of counselling) in the context of annual low-dose CT screening for lung cancer in people at high risk to lung cancer screening without a cessation intervention in Canada. The simulated population consisted of Canadians born in 1940-1974; lung cancer screening was offered to eligible people in 2020. In the base-case scenario, we assumed that the intervention would be offered to smokers up to 10 times; each intervention would achieve a 2.5% permanent quit rate. Sensitivity analyses varied key model inputs. We calculated incremental cost-effectiveness ratios with a lifetime horizon from the health system's perspective, discounted at 1.5% per year. Costs are in 2019 Canadian dollars.

RESULTS:

Offering a smoking cessation intervention in the context of lung cancer screening could lead to an additional 13% of smokers quitting smoking. It could potentially prevent 12 more lung cancers and save 200 more life-years for every 1000 smokers screened, at a cost of $22 000 per quality-adjusted life-year (QALY) gained. The results were most sensitive to quit rate. The intervention would cost over $50 000 per QALY gained with a permanent quit rate of less than 1.25% per attempt.

INTERPRETATION:

Adding a smoking cessation intervention to lung cancer screening is likely cost-effective. To optimize the benefits of lung cancer screening, health care providers should encourage participants who still smoke to quit smoking.

• Authors: William K Evans, Cindy L Gauvreau, William M Flanagan, Saima Memon, Jean Hai Ein Yong, John R Goffin, Natalie R Fitzgerald, Michael Wolfson, Anthony B Miller
• Journal: CMAJ open (CMAJ Open) 2020 Jul-Sep Vol. 8 Issue 3 Pg. E585-E592 ISSN: 2291-0026 [Print] Canada
• PMID: 32963023 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2020, Joule Inc. or its licensors.

Chemical References

• Smoking Cessation Agents
• Varenicline

Topics

• Aged
• Canada (epidemiology)
• Cohort Studies
• Cost-Benefit Analysis (methods)
• Counseling
• Early Detection of Cancer (economics, methods)
• Female
• Humans
• Lung Neoplasms (diagnostic imaging, epidemiology)
• Male
• Mass Screening (economics, methods)
• Middle Aged
• Models, Theoretical
• Quality-Adjusted Life Years
• Smoking (drug therapy, epidemiology)
• Smoking Cessation (economics)
• Smoking Cessation Agents (therapeutic use)
• Tobacco Use Cessation Devices
• Tomography, X-Ray Computed (methods)
• Varenicline (therapeutic use)