Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
J Natl Cancer Inst. 2021 Aug 2;113(8):1065-1073. doi: 10.1093/jnci/djab002.
Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches.
We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios.
Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence.
All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
指南建议向符合肺癌筛查条件的吸烟者提供戒烟干预措施，但在这种情况下，比较特定戒烟方法的数据很少。我们比较了不同戒烟干预措施的效益和成本，以帮助筛查计划选择特定的戒烟方法。
我们使用癌症干预和监测建模网络模型进行了一项基于社会视角的成本效益分析，该模型模拟了 1960 年出生的个体在其一生中的情况。模型输入来自医疗保险、国家癌症登记处、已发表的研究以及戒烟干预措施的微观成本。我们根据 2014 年美国预防服务工作组的指南模拟了每年的肺癌筛查，并为首次筛查的当前吸烟者提供了戒烟干预措施，包括仅使用药物治疗或药物治疗联合电子和/或基于网络的、电话、个人或小组咨询。结果包括肺癌病例和死亡、节省的生命年、质量调整生命年（QALY）、成本和增量成本效益比。
与单独筛查相比，所有戒烟干预措施均减少了肺癌的病例和死亡。与增量相比，有效的戒烟策略包括药物治疗联合基于网络的戒烟（每 QALY555 美元）、电话咨询（每 QALY7562 美元）或个体咨询（每 QALY35531 美元）。即使在干预效果最低的情况下，戒烟干预措施的成本效益仍然低于可接受的支付意愿阈值，而且在吸烟率较高的队列中更具成本效益。
与肺癌筛查一起提供的所有戒烟干预措施都可能以合理的成本提供效益。由于方法之间的差异很小，干预措施的选择应根据实际问题，如人员培训和可用性来指导。
