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Smoking cessation appears cost-effective for lung cancer screening program
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The addition of a smoking cessation intervention to a low-dose CT lung cancer screening program appeared cost-effective, according to data presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
A cessation program would cost less than $50,000 per quality-adjusted life year, even after multiple attempts to quit smoking, the research showed.
“We know lung cancer screening is a teachable moment,” William K. Evans, MD, FRCP, professor emeritus in the division of medical oncology at McMaster University in Ontario, Canada, said during a press conference. “Individuals show up annually for screening and if they are a smoker, it’s an opportunity to speak to them again about the hazards of smoking and use an aggressive approach of smoking cessation including nicotine replacement therapy and counseling over a 12-week period. We factored these into our microsimulation model.”
Previous research linked low-dose CT screening of smokers at high risk for lung cancer to reduced lung cancer-specific and overall mortality. Data from the National Lung Screening Trial suggested smoking cessation contributed to reduced mortality.
Pilot low-dose CT screening programs — with smoking cessation — are being implemented across practices in Ontario, Canada.
“We know that lung cancer screening can reduce lung cancer mortality but what would be the impact of introducing smoking cessation in terms of cost and cost-effectiveness?” Evans said.
The Canadian Partnership Against Cancer and Statistics Canada developed a microsimulation model (OncoSim-LC, version 2.5) to determine the impact of cancer control measures on lung cancer incidence, mortality and cost. The model incorporated Canadian demographics, risk factors, cancer management approaches, outcomes and resource use to measure any impact on clinical, economic and health care systems.
The model assumed individuals aged 55 to 74 years with a 30 or more pack-year smoking history underwent annual screening, one cessation intervention cost $490, up to 10 cessation attempts could be made, and each cessation attempt leads to a 5% permanent quit rate.
Researchers compared a base case of organized screening with no cessation to various screening scenarios that included cessation.
Researchers used a lifetime horizon, health system perspective and 1.5% discount rate to determine cost-effectiveness.
“We have to acknowledge that smoking cessation does not immediately lead to reduction in lung cancer and the model phases this in with lag time of over 10 years,” Evans said.
With 60% recruitment and 70% rescreening adherence, smoking cessation within a screening program would cost approximately $76 million per year between 2017 and 2036 if undiscounted. This equated to 8% of the total cost of screening, treatment and cessation.
Researchers observed an average 110 fewer incident lung cancer cases and 50 fewer deaths per year between 2017 and 2036, costing $14,000 per quality-adjusted life year with a lifetime horizon.
With 90% recruitment and 80% rescreening adherence, smoking cessation within a screening program would lead to 260 fewer deaths at a cost of $24,000 quality-adjusted life years.
“If you are really low in recruiting to your smoking cessation program and have low adherence rates, then you get a very ineffective cost-effective ratio,” Evans said. “The argument really is that you want to achieve a high recruitment rate, adherence and smoking cessation to get the optimal impact.”
At a doubled permanent quit rate of 10%, screening with cessation would cost $6,000 quality-adjusted life years.
Further, a 50% increase in the cost of cessation would decrease the cost-effectiveness of the program to $22,000 quality-adjusted life years.
“Is this important? Well, in publicly funded health care systems, we have to make a decision about how to use our resources,” Evans said. “When something is cost-effective, governments are much more inclined to accept a new intervention.”– by Melinda Stevens
Reference:
Evans WK, et al. Abstract 9642. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Oct. 15-18, 2017; Yokohama, Japan.
Disclosures: Evans reports no relevant financial disclosures. Please see the abstract for a full list of all other authors’ relevant financial disclosures.