Lung cancer screening with LDCT appears cost-effective in the publicly funded Canadian health care system. An adjunct smoking cessation program has the potential to improve outcomes.

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The Canadian Partnership Against Cancer was created in 2007 by the federal government to accelerate cancer control across Canada. Its OncoSim microsimulation model platform, which consists of a suite of specific cancer models, was conceived as a tool to augment conventional resources for population-level policy-and decision-making. The Canadian Partnership Against Cancer manages the OncoSim program, with funding from Health Canada and model development by Statistics Canada.Microsimulation modelling allows for the detailed capture of population heterogeneity and health and demographic history over time. Extensive data from multiple Canadian sources were used as inputs or to validate the model. OncoSim has been validated through expert consultation; assessments of face validity, internal validity, and external validity; and model fit against observed data. The platform comprises three in-depth cancer models (lung, colorectal, cervical), with another in-depth model (breast) and a generalized model (25 cancers) being in development. Unique among models of its class, OncoSim is available online for public sector use free of charge. Users can customize input values and output display, and extensive user support is provided.OncoSim has been used to support decision-making at the national and jurisdictional levels. Although simulation studies are generally not included in hierarchies of evidence, they are integral to informing cancer control policy when clinical studies are not feasible. OncoSim can evaluate complex intervention scenarios for multiple cancers.Canadian decision-makers thus have a powerful tool to assess the costs, benefits, cost-effectiveness, and budgetary effects of cancer control interventions when faced with difficult choices for improvements in population health and resource allocation.

L ung cancer is the leading cause of death from cancer in Canada. 1 Low-dose computed tomography (CT) screening has been shown to reduce lung cancer mortality and is now recommended for people at high risk. 2-5 In addition to early detection of lung cancer, a low-dose CT screening program provides an opportunity to help current smokers quit and to support those who have recently quit, as the encounter with the screening program is a teachable moment and an opportunity to refer patients for assistance with smoking cessation. 6-8 Using data from the National Lung Screening Trial, 2 Tanner and colleagues 9 estimated that screening and 15 years of abstinence would almost double the mortality risk reduction from lung cancer screening alone. Several clinical trials are underway to test the impact of various smoking cessation interventions in the context of low-dose CT screening, but their results will not be available soon. 10 In the interim, simulation models can help to address the evidence gaps and inform decisions regarding implementation of low-dose CT screening. In this study, we aimed to estimate the impact of adding a smoking cessation intervention to a low-dose CT screening program on long-term clinical benefits, health system costs and costeffectiveness using a microsimulation model. Methods Population In this analysis, we simulated a cohort of people born in 1940-1974 in Canada and compared their lifetime outcomes. To compare addition of a smoking cessation intervention with no intervention in the context of low-dose CT screening, we modelled a low-dose CT screening program for people at high risk in Canada starting in 2020 using the eligibility criteria for age and smoking history recommended by the Canadian Task Force on Preventive Health Care 3 (Table 1). Participants were screened annually in the model as long as they met the eligibility criteria.