Integrating smoking cessation in lung cancer CT screening may reduce healthcare costs
Integrating robust smoking cessation programs with organized low-dose CT (LDCT) lung cancer screening may decrease mortality rates while being relatively cost-effective, according to a modelling study.
Using a microsimulation model called OncoSim-LC developed by Statistics Canada, a team of researchers led by Dr William Evans of McMaster University, Canada, compared LDCT screening without an accompanying cessation program to screening scenarios with cessation interventions, projected over 20 years. Cost-effectiveness was estimated based on a lifetime horizon, health system perspective and 1.5 percent discount rate, with costs reported in 2016 Canadian dollars (CA$).
“We know that lung cancer screening is a teachable moment,” said Evans, who noted that the model factored the impacts of an aggressive approach of smoking cessation, including nicotine replacement therapy, varenicline and counseling over a 12-week period.
Results from the model showed that within those 20 years, cessation within a screening program with a 60 percent recruitment rate (RR) and 70 percent adherence rate (AR) would cost approximately CAD$76 million annually, or 8 percent of the total cost of screening, treatment and cessation. Compared to screening with no cessation, approximately 110 fewer incident cases and 50 fewer lung cancer deaths would occur on average per year, at a cost of CA$14,000 per quality-adjusted year of life (QALY). [WCLC 2017;abstract ID 9642]
“A robust smoking cessation initiative allowing multiple quit attempts—and we go up to 10 quit attempts in our model—within a LDCT screening program could save lives while costing around CA$14,000 per QALY,” said Evans. “To put that in some context, various countries use different thresholds for cost-effectiveness, but in Canada at the moment around CA$100,000 per QALY is an acceptable level for a healthcare intervention. This is well below that, so this is a highly acceptable cost-effectiveness ratio.”
Presenting the team’s findings at the International Association for the Study of Lung Cancer (IASLC) 18th World Conference on Lung Cancer (WCLC) in Yokohama, Japan, Evans added that particularly for publicly-funded healthcare systems with limited resources, governments were much more inclined to accept demonstrably cost-effective interventions.
However, he cautioned that the model’s projected reduction in the incidence of lung cancer obviously varied with the assumed cessation rate, and little data presently exists on the cessation rate often achieved in the context of the Canadian LDCT screening program. The OncoSim model examined outcomes with a cessation rate range of 2.5 to 20 percent, and factored lag times between cessation and lung cancer impacts.
“On the other hand, [based on our model] when we have lower recruitment rates, it doesn’t matter whether smoking cessation is 5 percent or higher—you’re not going to get as much benefit,” said Evans. “You want to achieve a combination of high recruitment rate, high adherence, and high smoking cessation to get the optimal impact.”
Developed by Statistics Canada and supported by Health Canada and The Canadian Partnership against Cancer, OncoSim-LC incorporated data from Canadian demographic characteristics, risk factors, cancer management approaches and outcomes and resource utilization. Evans noted that financial data in the model was based on standards of care for lung cancer in 2010, and needed to be updated to reflect new treatments such as immunotherapy, which is expected to lead to substantial cost increases.