RT Journal Article
SR Electronic
T1 Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E585
OP E592
DO 10.9778/cmajo.20190134
VO 8
IS 3
A1 Evans, William K.
A1 Gauvreau, Cindy L.
A1 Flanagan, William M.
A1 Memon, Saima
A1 Yong, Jean Hai Ein
A1 Goffin, John R.
A1 Fitzgerald, Natalie R.
A1 Wolfson, Michael
A1 Miller, Anthony B.
YR 2020
UL http://www.cmajopen.ca/content/8/3/E585.abstract
AB 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.