Abstract
Quitting smoking after a diagnosis of cancer results in greater response to treatment and decreased risk of disease recurrence and second primary cancers. The objective of this study was to evaluate the potential cost‐effectiveness of two smoking cessation approaches: the current basic smoking cessation program consisting of screening for tobacco use, advice, and referral; and a best practice smoking cessation program that includes the current basic program with the addition of pharmacological therapy, counseling, and follow‐up. A Markov model was constructed that followed 65‐year‐old smokers with cancer over a lifetime horizon. Transition probabilities and mortality estimates were obtained from the published literature. Costs were obtained from standard costing sources in Ontario and reports. Probabilistic and deterministic sensitivity analyses were conducted to address parameter uncertainties. For smokers with cancer, the best practice smoking cessation program was more effective and more costly than the basic smoking cessation program. The incremental cost‐effectiveness ratio of the best practice smoking cessation program compared to the basic smoking cessation program was $3367 per QALY gained and $5050 per LY gained for males, and $2050 per QALY gained and $4100 per LY gained for females. Results were most sensitive to the hazard ratio of mortality for former and current smokers, the probability of quitting smoking through participation in the program and smoking‐attributable costs. The study results suggested that a best practice smoking cessation program could be a cost‐effective option. These findings can support and guide implementation of smoking cessation programs.
Highlights
Smoking is a leading cause of mortality and the leading cause of preventable death in Canada [1]
The best practice smoking cessation program for smokers was more effective (0.03 QALYs gained for males and 0.02 for females) and more costly than the basic smoking cessation program
One-way sensitivity analysis revealed that the results were most sensitive to the hazard ratio for mortality for former and current smoker cancer patients, the annual health care cost of cancer patients after diagnosis, the probability of quitting due to the basic smoking cessation program, and smoking-attributable cost (Fig. 2)
Summary
Smoking is a leading cause of mortality and the leading cause of preventable death in Canada [1]. Smoking results in an increased risk of all-cause and cancer-specific mortality [2]. In Ontario, Canada, approximately 77,000 new cancer cases are diagnosed each year [4]. 20% of these persons are current smokers at the time of cancer diagnosis and 30–60% of them continue smoking after diagnosis [5]. Basic program administration cost (per $16 patient; one-time cost). Admin cost for basic program sensitivity analyses, we used gamma distributions to represent uncertainty in the cost parameters because cost data are typically skewed and cannot be negative. We summarized the results on a cost-effectiveness plane
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