TY - JOUR T1 - Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model JF - CMAJ Open JO - CMAJ SP - E585 LP - E592 DO - 10.9778/cmajo.20190134 VL - 8 IS - 3 AU - William K. Evans AU - Cindy L. Gauvreau AU - William M. Flanagan AU - Saima Memon AU - Jean Hai Ein Yong AU - John R. Goffin AU - Natalie R. Fitzgerald AU - Michael Wolfson AU - Anthony B. Miller Y1 - 2020/07/01 UR - http://www.cmajopen.ca/content/8/3/E585.abstract N2 - Background: Low-dose computed tomography (CT) screening can reduce lung cancer mortality in people at high risk; adding a smoking cessation intervention to screening could further improve screening program outcomes. This study aimed to assess the impact of adding a smoking cessation intervention to lung cancer screening on clinical outcomes, costs and cost-effectiveness.Methods: Using the OncoSim-Lung mathematical microsimulation model, we compared the projected lifetime impact of a smoking cessation intervention (nicotine replacement therapy, varenicline and 12 wk of counselling) in the context of annual low-dose CT screening for lung cancer in people at high risk to lung cancer screening without a cessation intervention in Canada. The simulated population consisted of Canadians born in 1940–1974; lung cancer screening was offered to eligible people in 2020. In the base-case scenario, we assumed that the intervention would be offered to smokers up to 10 times; each intervention would achieve a 2.5% permanent quit rate. Sensitivity analyses varied key model inputs. We calculated incremental cost-effectiveness ratios with a lifetime horizon from the health system’s perspective, discounted at 1.5% per year. Costs are in 2019 Canadian dollars.Results: Offering a smoking cessation intervention in the context of lung cancer screening could lead to an additional 13% of smokers quitting smoking. It could potentially prevent 12 more lung cancers and save 200 more life-years for every 1000 smokers screened, at a cost of $22 000 per quality-adjusted life-year (QALY) gained. The results were most sensitive to quit rate. The intervention would cost over $50 000 per QALY gained with a permanent quit rate of less than 1.25% per attempt.Interpretation: Adding a smoking cessation intervention to lung cancer screening is likely cost-effective. To optimize the benefits of lung cancer screening, health care providers should encourage participants who still smoke to quit smoking. ER -