Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model

Abstract

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.

Impact of Joint Lung Cancer Screening and Cessation Interventions Under the New Recommendations of the U.S. Preventive Services Task Force

“…Consistent with other studies, 3,7,[12][13][14] the analysis indicates that joint LDCT screening and cessation interventions could result in important reductions in lung cancer and overall tobacco-related premature mortality. In particular, by expanding the number of smokers eligible for screening to include younger smokers with fewer pack-years, many of whom are projected to be women and racial/ethnic minorities, 5 the 2021 USPSTF recommendations could result in more life-years gained than previous criteria and be more equitable.…”

“…Previous studies have projected the potential impact of cessation interventions at the point of LDCT screening under previous screening guidelines, 3,7,[12][13][14] or the benefits and harms of expanding screening to individuals with 20 or more pack-years of smoking history, but without consideration of joint screening cessation interventions.5 Here, we extend previous studies by quantifying the potential impact of screening according to the 2021 USPSTF recommendations with joint cessation interventions.…”

Guía de Práctica Clínica para el diagnóstico temprano y la referencia oportuna del cáncer de pulmón

“…En el contexto de tamizaje de CP, la abstinencia tabáquica ofrece un beneficio adicional de 15% en sobrevida y es una oportunidad de incentivar a los fumadores a recibir tratamiento y de evitar recaídas en los exfumadores. 20 5. No se recomienda el tamizaje con citología seriada de esputo en pacientes con alto riesgo de desarrollar CP:…”

Lung cancer screening primer

“…37 Increased smoking cessation has been modeled to be cost-effective and, independent of screening, would prevent the development of lung cancers and improve mortality. 38 Equity. A higher smoking incidence is strongly associated with lower socioeconomic status (SES), rurality, and Indigenous populations.…”