Lung screenings paired with phone-based smoking cessation programs could save lives, money

Integrating telephone-based smoking cessation and lung screening programs not only have the potential to maximize long-term health benefits, but they can also be cost-effective in the long term, according to a University of Michigan-led study. 

"We hope the results will inform discussions about the integration of cost-effective cessation approaches for smokers receiving lung cancer screening," said lead author Pianpian Cao, a research fellow at the U-M School of Public Health’s Department of Epidemiology. 

Cao and colleagues used data from a national, randomized trial conducted by investigators at the Georgetown Lombardi Comprehensive Cancer Center to evaluate the short- and long-term societal cost-effectiveness of interventions, including phone counseling with nicotine replacement therapy among individuals receiving lung cancer screenings. They used a well-established model developed by the Cancer Intervention and Surveillance Modeling Network to project the lifetime impact of the program to conduct an economic analysis of these cessation interventions.  

According to the researchers, the cost for delivery of the programs was $380 and $144 per person for the eight-week and three-week protocol, respectively, while quit 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.   

While the three-week program was less expensive per person than the eight-week approach, the latter was most cost-effective, with an incremental cost-effectiveness ratio of $4,029 per quality-adjusted life-year vs. the three-week program. 

Investigators say this is the first study to conduct an economic evaluation of a large, national clinical trial of a telephone counseling intervention for smokers at the time of lung cancer screening and to use that data to project lifetime costs and effects.   

According to early recommendations by the U.S. Preventive Services Task Force, about 8 million people in the United States are eligible for screening and about half of those are current smokers. The task force recently upgraded the recommendations, but data to guide the implementation of smoking cessation programs is still limited. 

"Screening can be a teachable moment, providing the opportunity to motivate individuals who currently smoke to quit, but until now the data to guide implementation of smoking cessation programs in lung cancer screening settings is limited," said the study's senior author Rafael Meza, professor of epidemiology and global public health at U-M’s 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 screening-eligible smokers in the U.S."  

Because of the study's limited scope, the results should be taken as a conservative estimate of the net benefits, the researchers say. The analysis did not include sufficient numbers of racial/ethnic minorities to assess subgroup effects. Also, adherence to lung cancer screenings vary widely by state and race, differences that need to be evaluated in future studies.  

"That being said, the results strongly support implementing telephone counseling and other effective cessation interventions within lung cancer screening," Cao said. 

The study appears in this month's Journal of the National Cancer Institute. It was supported by the National Cancer Institute at the National Institutes of Health. 

Study: A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting