PURPOSE: Lung cancer is the leading cause of cancer-related mortality. Smoking cessation programs are cost effective in a wide variety of clinical settings and decrease the incidence of lung cancer. Although there is a mortality benefit to quitting smoking even up to the time of surgery for lung cancer removal, it is not known if implementing a smoking cessation program is cost effective.
METHODS: A decision analysis model was created in which a hypothetical cohort of patients underwent a smoking cessation program after receiving a diagnosis of surgically resectable lung cancer for stage IIIA and less NSCLC. The mortality associated with smoking cessation up to the time of surgery, expected effectiveness of a smoking cessation program, the utility of lung cancer survivors who smoke and do not smoke, and the costs of a smoking cessation program were derived from the literature. Cost effectiveness was defined as a cost of less than $60,000 per quality-adjusted life-year (QALY) gained in the cohort undergoing a smoking cessation program compared with controls who did not.
RESULTS: In the initial (base case) analysis, the cost of a smoking cessation program was $1502 per QALY gained and $1823 for every life saved. Sensitivity analyses that included assumptions derived from the literature demonstrated that costs per QALY varied from approximately $400 to $30,000. The cost effectiveness was most sensitive to the cost of the smoking cessation program and even with a cost of $500 for the smoking cessation program, the cost per QALY was approximately $25,500, well below the $60,000 threshold.
CONCLUSION: A smoking cessation program implemented at the time of diagnosis of surgically resectable lung cancer may be cost effective throughout a wide range of costs and mortality estimations.
CLINICAL IMPLICATIONS: Smoking cessation programs may be cost effective even in patients with lung cancer.
DISCLOSURE: Christopher Slatore, None.