Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Abstract

Background: There are limited data on the cost-effectiveness of smoking cessation interventions in lung cancer screening settings. We conducted an economic analysis embedded in a national randomized trial of 2 telephone counseling cessation interventions.

Methods: We used a societal perspective to compare the short-term cost per 6-month bio-verified quit and long-term cost-effectiveness of the interventions. Trial data were used to micro-cost intervention delivery, and the data were extended to a lifetime horizon using an established Cancer Intervention Surveillance and Modeling Network lung cancer model. We modeled the impact of screening accompanied by 8 weeks vs 3 weeks of telephone counseling (plus nicotine replacement) vs screening alone based on 2021 screening eligibility. Lifetime downstream costs (2021 dollars) and effects (life-years gained, quality-adjusted life-years [QALYs]) saved were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed nonrelapse after quitting.

Results: The costs for delivery of the 8-week vs 3-week protocol were $380.23 vs $144.93 per person, and quit rates were 7.14% vs 5.96%, respectively. The least costly strategy was a 3-week counseling approach. An 8-week (vs 3-week) counseling approach increased costs but gained QALYs for an incremental cost-effectiveness ratio of $4029 per QALY. Screening alone cost more and saved fewer QALYs than either counseling strategy. Conclusions were robust in sensitivity analyses.

Conclusions: Telephone-based cessation interventions with nicotine replacement are considered cost-effective in the lung screening setting. Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.

Figure 1.

Incremental cost-effectiveness ratios (ICERs) comparing 8-week to 3-week telephone counseling for the main and sensitivity analyses. The vertical black line across each bar represents the ICER for 8-week telephone counseling under the base-case scenario from Table 4 ($4029/quality-adjusted life-year). The sensitivity analyses from the top down are: best or worst case—8-week counseling compared with 3-week counseling at the highest effect difference (8-week: smoking cessation intervention relative risk [RR] = 3.68 vs 3-week: RR = 1.39) and the lowest cost difference (8-week: $310.80 vs 3-week: $172.96) vs 8-week compared with 3-week counseling at the lowest effect difference (8-week [RR] = 1.77 and 3-week: RR = 1.39) and the highest cost difference (8-week: $449.64 vs 3-week: $116.91) using 6-month bio-verified quit rates under the 2021 United States Preventive Service Task Force (USPSTF) guidelines.^a Highest and lowest bio-verified efficacy: 8-week counseling compared with 3-week counseling with the highest effect difference (8-week: RR = 3.68 vs 3-week: RR = 1.39) vs the lowest effect difference (8-week: RR = 1.77 vs 3-week: RR = 1.39) at base-case costs using 6-month bio-verified quit rates under the 2021 USPSTF guidelines. Highest and lowest costs: 8-week counseling compared with 3-week counseling with the highest cost difference (8-week: $449.64 vs 3-week: $116.91) vs lowest cost difference (8-week: $310.80 vs 3-week: $172.96) at base-case efficacies using 6-month bio-verified quit rates under the 2021 USPSTF guidelines. Background cessation rate: varying the “no-intervention” cessation rate obtained from the Tobacco Use Supplement to the Current Population Survey over its 95% confidence interval with base-case intervention efficacy and costs. ^a2021 USPSTF guidelines: individuals between age 50 and 80 years, smoked 20 pack-years or more, and currently smoking or quit within 15 years are eligible for lung cancer screening.