Cost-Effectiveness of a Telephone-based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting
Ce dossier présente deux études qui, menées à partir des données d'un essai randomisé multicentrique et d'une modélisation, analysent à court terme le rapport coût-efficacité d'une intervention de sevrage tabagique associant conseil téléphonique et remplacement de la nicotine chez les personnes bénéficiant d'un dépistage du cancer du poumon, et estiment l'impact de cette intervention sur la mortalité liée au tabac et sur la durée de vie
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.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.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.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.