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Review
. 2022 Sep 26;29(10):6982-6991.
doi: 10.3390/curroncol29100549.

Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients

Jeffrey S Hoch  1   2 , Heather K Barr  3 , Andrea M Guggenbickler  3 , Carolyn S Dewa  4
Affiliations
Review

Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients

Jeffrey S Hoch et al. Curr Oncol. .

Abstract

Background: Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments.

Methods: Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs.

Results: The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients' lives.

Conclusion: The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.

Keywords: cost-effectiveness analysis; economic evaluation; value of smoking cessation programs.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of the key parts in an economic evaluation of a smoking cessation program. Note: Figure 1 illustrates a “general” decision tree used to calculate the expected value of a smoking cessation program (SCP) vs. no SCP with two “chance” events: (1) people quit; and (2) quitting leads to better outcomes. The SCP option has shaded boxes and the no SCP option does not.
Figure 2
Figure 2
How many people from a population of n = 100 are helped by a smoking cessation program as a function or the proportion who quit and the proportion who benefit from quitting. Note: Figure 2 illustrates a “two-way” sensitivity analysis illustrating the impact of different assumptions about the two main “chance” events: (1) additional proportion of people who quit (i.e., ΔE1); and (2) additional proportion who gain better outcomes from quitting (i.e., ΔE2). The shaded area indicates how many people will benefit out of a hypothetical population of 100 given assumed values for ΔE1 and ΔE2. At ΔE2 = 10%, 10% increases in ΔE1 increases the number of people helped by one (as indicated by the labels over the points marked with an ×. At ΔE2 = 100%, 10% increases in ΔE1 increases the number of people helped by ten (as indicated by the shaded regions).
Figure 3
Figure 3
The “number needed to treat” (NNT) with a smoking cessation program for one more person to benefit. Note: Figure 3 illustrates a “two-way” sensitivity analysis illustrating the impact of different assumptions about the two main “chance” events: (1) additional proportion of people who quit (i.e., ΔE1); and (2) additional proportion who gain better outcomes from quitting (i.e., ΔE2). The shaded areas indicate number needed to treat (NNT) given assumed values for ΔE1 and ΔE2. Larger NNT values require more smokers being “treated” with a smoking cessation program (SCP) before one is helped.
Figure 4
Figure 4
Cost-effectiveness plane. Note: Figure 4 illustrates results reported in the peer-reviewed scientific literature on smoking cessation programs (SCPs) estimating the extra quality-adjusted life years (ΔQALYs) and the extra costs in 2022 Canadian dollars (ΔC). The ratio ΔC/ΔE (i.e., the incremental cost-effectiveness ratio or ICER) is shown as the label for each point. Diamond points (i.e., ♦) show results from studies of SCPs for cancer patients while circular points (i.e., ○) show study results for SCPs supplementing cancer screening programs.
Figure 5
Figure 5
Estimates of the incremental cost-effectiveness ratio (ICER = ΔC and ΔE estimates) in 2022 Canadian dollars by study type [15,16,17,18,19,21,22]. Note: Figure 5 illustrates the estimates and ranges for the extra cost per extra QALY (in $10,000′s) as reported in the peer-reviewed scientific literature on smoking cessation programs (SCPs). The ratio ΔC/ΔE (i.e., the incremental cost-effectiveness ratio or ICER) is shown as the label for each point. Results from studies of SCPs for cancer patients appear above while study results for SCPs supplementing cancer screening programs appear below. Missing from the studies of SCPs as part of screening are the results from Goffin et al. (2016) [20]. Interested readers are directed to Table 2 in the Goffin et al paper for 14 different estimates conveying that SCPs are more effective and more costly).
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