Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients with Cancer.
Thursday, June 16, 2022
Posted by: Natalia Gromov
Levy DE, Regan S, Perez GK,
et al.
Cost-effectiveness of
Implementing Smoking Cessation Interventions for Patients with Cancer.
JAMA Netw Open. 2022;5(6):e2216362. Published 2022 Jun 1.
doi:10.1001/jamanetworkopen.2022.16362
Importance.
Guidelines recommend cancer care clinicians offer smoking cessation treatment.
Cost analyses will help stakeholders understand and plan for implementation of
cessation programs.
Objective.
To estimate the incremental cost per quit (ICQ) of adopting an intensive
smoking cessation intervention among patients undergoing treatment at cancer
care clinics, from a clinic perspective.
Design, setting, and
participants. This economic evaluation, a secondary analysis of
the Smokefree Support Study (conducted 2013-2018; completed 2021), used
microcosting methods and sensitivity analyses to estimate the ICQ of the
interventions. Participants included patients undergoing treatment for a broad
range of solid tumors and lymphomas who reported current smoking and were
receiving care at cancer care clinics within 2 academic medical centers.
Exposures.
Intensive smoking cessation treatment (up to 11 counseling sessions with free
medications), standard of care (up to 4 counseling sessions with medication
advice), or usual care (referral to the state quitline).
Main outcomes and measures.
Total costs, component-specific costs, and the ICQ of the intensive smoking
cessation treatment relative to both standard of care (comparator in the parent
randomized trial) and usual care (a common comparator outside this trial) were
calculated. Overall and post hoc site-specific estimates are provided. Because
usual care was not included in the parent trial, sensitivity analyses were
conducted to assess how assumptions about usual care quit rates affected study
outcomes (ie, base case [from a published smoking cessation trial among
patients with thoracic cancer], best case, and conservative case scenarios).
Results.
The per-patient costs of offering intensive smoking cessation treatment,
standard of care, and usual care were $1989, $1482, and $0, respectively. For
intensive treatment, the dominant costs were treatment (35%), staff supervision
(26%), and patient enrollment (24%). Relative to standard of care, intensive
treatment had an overall ICQ of $3906, and one site had an ICQ of $2892. Relative
to usual care, intensive treatment had an ICQ of $9866 overall (base case),
although at one site, the ICQ was $5408 (base case) and $3786 (best case).
Conclusions and relevance.
In this economic evaluation study, implementation of an intensive smoking cessation
treatment intervention was moderately to highly cost-effective, depending on
existing smoking cessation services in place.
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