Integrating telephone smoking cessation and lung screening programs not only has the potential to maximize long-term health benefits, but may also be cost-effective in the long run, according to a study led by the University of Michigan.
We hope that the results will inform discussions about integrating cost-effective cessation approaches in smokers undergoing lung cancer screening.
Pianpian Cao, lead author, research associate, UM School of Public Health Department of Epidemiology
Cao and colleagues used data from a national, randomized trial conducted by researchers at the Georgetown Lombardi Comprehensive Cancer Center to evaluate the short- and long-term social cost-effectiveness of interventions including telephone counseling with nicotine replacement therapy among individuals screened for lung cancer . They used a well-established model developed by the Cancer Intervention and Surveillance Modeling Network to project lifetime program impacts to perform an economic analysis of these smoking cessation interventions.
According to the researchers, the costs of delivering the programs were $380 and $144 per person for the eight-week and three-week protocols, respectively, while dropout rates were 7.14% and 5.96%. They also found differences in “quality-adjusted life years,” or QALYs, a measure of the value of health outcomes often used in economic evaluations of health interventions.
Although the three-week program was less expensive per person than the eight-week approach, the latter was the most cost-effective, with an incremental cost-effectiveness ratio of $4029 per quality-adjusted life year over the three-week program.
Researchers say this is the first study to conduct an economic evaluation of a large national clinical trial of a telephone counseling intervention for smokers during lung cancer screening and use these data to predict lifetime costs and effects.
According to early recommendations from the US Preventive Services Task Force, about 8 million people in the United States are eligible for screening, and about half of them are current smokers. The task force recently updated the recommendations, but data to guide the implementation of smoking cessation programs are still limited.
“Screening can be a teachable moment, providing an opportunity to motivate people who currently smoke to quit, but to date, data to guide the implementation of smoking cessation programs in lung cancer screening are limited,” said Chief study author Rafael Meza, professor of epidemiology and global public health in the UM School of Public Health.
“These results provide important evidence for the value of smoking cessation in the setting of lung cancer screening and underscore the need to maintain reimbursement policies supporting this approach for the millions of smokers eligible for screening in the US.”
Because of the limited scope of the study, the results should be taken as a conservative estimate of net benefits, the researchers said. The analysis did not include a sufficient number of racial/ethnic minorities to assess subgroup effects. Also, adherence to lung cancer screenings varies significantly by state and race, differences that should be evaluated in future studies.
“That being said, the results strongly support the implementation of telephone counseling and other effective smoking cessation interventions as part of lung cancer screening,” Cao said.
The study appears in the Journal of the National Cancer Institute this month. It was supported by the National Cancer Institute of the National Institutes of Health.
Randomized trial of telephone-based smoking cessation treatment in lung cancer screening