Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Apr 5;2(4):e191703.
doi: 10.1001/jamanetworkopen.2019.1703.

Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer

Graham W Warren  1   2 , Kathleen B Cartmell  3 , Elizabeth Garrett-Mayer  4 , Ramzi G Salloum  5 , K Michael Cummings  6
Affiliations
Comparative Study

Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer

Graham W Warren et al. JAMA Netw Open. .

Abstract

Importance: Previous studies have shown that continued smoking among patients with cancer can increase overall and cancer-specific mortality, risk for second primary cancer, and risk for toxic effects of cancer treatment. To our knowledge, there have been no efforts to estimate additional costs for cancer treatment attributed to smoking.

Objective: To model attributable incremental costs of subsequent cancer treatment associated with continued smoking by patients with cancer.

Design, setting, and participants: For this economic evaluation, a model was developed in 2018 using data from a 2014 US Surgeon General's report that considered expected failure rates of first-line cancer treatment in nonsmoking patients, smoking prevalence, odds ratio of first-line cancer treatment failure attributed to smoking compared with nonsmoking, and cost of cancer treatment after failure of first-line cancer treatment.

Main outcomes and measures: Attributable failures of first-line cancer treatment and incremental cost for subsequent treatment associated with continued smoking among patients with cancer.

Results: Attributable treatment failures were higher under conditions in which high first-line cure rates were expected in nonsmoking patients compared with conditions in which low cure rates were expected. Peak attributable failures occurred under the conditions in which expected cure rates among nonsmoking patients ranged from 50% to 65%. Under the conditions of a 30% expected treatment failure rate among nonsmoking patients, 20% smoking prevalence, 60% increased risk of failure of first-line cancer treatment, and $100 000 mean added cost of treating a first-line cancer treatment failure, the additional incremental cost per 1000 total patients was estimated to be $2.1 million, reflecting an additional cost of $10 678 per smoking patient. Extrapolation of cost to 1.6 million patients with cancer diagnosed annually reflects a potential $3.4 billion in incremental cost.

Conclusions and relevance: The findings suggest that continued smoking among patients with cancer and the increase in attributable first-line cancer treatment failure is associated with significant incremental costs for subsequent cancer treatments. Additional work appears to be needed to identify optimal methods to mitigate these incremental costs.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Garrett-Mayer reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Cummings reported receiving personal fees from Pfizer during the conduct of the study and receiving personal fees from various plaintiff law firms outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Attributable Failure per 1000 Total Patients Due to Continued Smoking
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2019.1713

References

    1. Tefferi A, Kantarjian H, Rajkumar SV, et al. . In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clin Proc. 2015;90(8):-. doi:10.1016/j.mayocp.2015.06.001 - DOI - PMC - PubMed
    1. Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153-165. doi:10.3322/caac.21443 - DOI - PMC - PubMed
    1. American Society of Clinical Oncology American Society of Clinical Oncology position statement on addressing the affordability of cancer drugs. J Oncol Pract. 2018;14(3):187-192. doi:10.1200/JOP.2017.027359 - DOI - PubMed
    1. Ellis LM, Bernstein DS, Voest EE, et al. . American Society of Clinical Oncology perspective: raising the bar for clinical trials by defining clinically meaningful outcomes. J Clin Oncol. 2014;32(12):1277-1280. doi:10.1200/JCO.2013.53.8009 - DOI - PubMed
    1. Kumar H, Fojo T, Mailankody S. An appraisal of clinically meaningful outcomes guidelines for oncology clinical trials. JAMA Oncol. 2016;2(9):1238-1240. doi:10.1001/jamaoncol.2016.0931 - DOI - PMC - PubMed

Publication types

Substances