Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening...

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Published inJNCI : Journal of the National Cancer Institute Vol. 113; no. 8; pp. 1065 - 1073
Main Authors Cadham, Christopher J, Cao, Pianpian, Jayasekera, Jinani, Taylor, Kathryn L, Levy, David T, Jeon, Jihyoun, Elkin, Elena B, Foley, Kristie L, Joseph, Anne, Kong, Chung Yin, Minnix, Jennifer A, Rigotti, Nancy A, Toll, Benjamin A, Zeliadt, Steven B, Meza, Rafael, Mandelblatt, Jeanne
Format Journal Article
LanguageEnglish
Published United States Oxford University Press 02.08.2021
Oxford Publishing Limited (England)
Subjects
Aged
Cancer screening
Cigarette smoking
Cost analysis
Cost benefit analysis
Counseling
Drug addiction
Drug therapy
Early Detection of Cancer
Fatalities
Guidelines
Humans
Intervention
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - epidemiology
Lung Neoplasms - prevention & control
Medical screening
Medicare
Middle Aged
Pharmacology
Quality-Adjusted Life Years
Smoking
Smoking Cessation
United States - epidemiology
United States
Online AccessGet full text
ISSN0027-8874
1460-2105
1460-2105
DOI10.1093/jnci/djab002

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Abstract Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
AbstractList Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches.BACKGROUNDGuidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches.We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios.METHODSWe conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios.Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence.RESULTSCompared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence.All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.CONCLUSIONAll smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
Author Rigotti, Nancy A
Meza, Rafael
Joseph, Anne
Minnix, Jennifer A
Jeon, Jihyoun
Taylor, Kathryn L
Foley, Kristie L
Jayasekera, Jinani
Toll, Benjamin A
Mandelblatt, Jeanne
Kong, Chung Yin
Cao, Pianpian
Elkin, Elena B
Levy, David T
Zeliadt, Steven B
Cadham, Christopher J
AuthorAffiliation 10 Department of Health Services, School of Public Health, University of Washington , Seattle, WA, USA
2 Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, MI, USA
4 Department of Implementation Science, Wake Forest School of Medicine , Winston-Salem, NC, USA
6 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York, NY, USA
7 Department of Behavioral Science, University of Texas MD Anderson Cancer Center , Houston, TX, USA
9 Department of Public Health Sciences and Psychiatry, Medical University of South Carolina , Charleston, SC, USA
11 Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System , Seattle, WA, USA
3 Department of Health Policy and Management at Columbia University Mailman School of Public Health , New York, NY, USA
8 Department of Medicine and Mongan Institute, Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School , Boston,
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/33484569$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Contributor Jayasekera, Jinani
Meza, Rafael
Mandelblatt, Jeanne
Cao, Pianpian
Jeon, Jihyoun
Taylor, Kathryn L
Levy, David T
Cadham, Christopher J
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Copyright The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com 2021
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The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
Copyright_xml – notice: The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com 2021
– notice: The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
– notice: The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
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Christopher J Cadham and Pianpian Cao contributed equally as first authors for this manuscript.
Rafael Meza and Jeanne Mandelblatt contributed equally as senior authors for this manuscript.
Christopher J. Cadham, Pianpian Cao, Jinani Jayasekera, Kathryn L. Taylor, David T. Levy, Jihyoun Jeon, Rafael Meza and Jeanne Mandelblatt were the writing committee for this manuscript
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Snippet Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing...
Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation...
Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific...
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SubjectTerms Aged
Cancer screening
Cigarette smoking
Cost analysis
Cost benefit analysis
Counseling
Drug addiction
Drug therapy
Early Detection of Cancer
Fatalities
Guidelines
Humans
Intervention
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - epidemiology
Lung Neoplasms - prevention & control
Medical screening
Medicare
Middle Aged
Pharmacology
Quality-Adjusted Life Years
Smoking
Smoking Cessation
United States - epidemiology
Title Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study
URI https://www.ncbi.nlm.nih.gov/pubmed/33484569
https://www.proquest.com/docview/2576679048
https://www.proquest.com/docview/2480522906
https://pubmed.ncbi.nlm.nih.gov/PMC8502465
https://www.ncbi.nlm.nih.gov/pmc/articles/8502465
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