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 two 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 saved [QALYs]) were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed non-relapse 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 $4,029 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.

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…The incremental costs per QALY gained were estimated to be larger with the 8-weeks intensive counselling. 47 Results from our current review, suggest that providing more support (multiple counselling sessions and pharmacotherapy) compared with less-intensive approaches, may be more favourable for a screening population. However, there were only limited direct comparison data, leading to only a recommendation of moderate certainty.…”

Effect of a mindfulness training app on a cigarette quit attempt: an investigator-blinded, 58-county randomized controlled trial

“…For example, our remote research protocols for recruitment, interviewing, and surveying can be replicated at relatively low cost in future studies designed to examine longer periods of mindfulness training or mindfulness training combined with pharmacotherapy, such as nicotine replacement therapy. In support of this future aim, previous studies have identified telehealth approaches (eg, delivery of quit-smoking counseling by telephone) combined with nicotine replacement therapy to be a cost-effective strategy for cessation in clinical settings ( 39 ). Our interpretations of this trial’s results are limited in a few ways.…”

Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study

“…Results of the RCT showed that delivering intensive telephone counseling and nicotine replacement therapy with lung cancer screening is an effective strategy to increase smoking cessation at month 3 ( 43 ). Moreover, in a cost-effectiveness analysis of the intervention, telephone counseling and nicotine replacement therapy were considered cost-effective in lung cancer screening settings ( 44 ). Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.…”