Economic Evaluation of Tobacco Treatments From the Screen ASSIST Lung Cancer Screening Trial

Importance Integrating smoking cessation interventions within lung cancer screening (LCS) programs may significantly reduce smoking-related morbidity and mortality. Data on costs and cost-effectiveness of smoking cessation interventions in the context of LCS can foster the dissemination of effective treatments. Objective To evaluate the cost-effectiveness from a health system perspective of 8 smoking cessation treatment strategies evaluated in the context of the Screen Aiding Screening Support In Stopping Tobacco (ASSIST) trial among patients undergoing LCS in 1 large health care system. Design, Setting, and Participants The Screen ASSIST trial used a 3-way factorial design testing the effectiveness of 8 combinations of smoking cessation treatments at a health system in Massachusetts with 11 participating LCS sites. In this economic evaluation, costs and cost-effectiveness were evaluated prospectively and contextualized through sensitivity analyses. Participants included English-speaking and Spanish-speaking patients who smoked and were scheduled for LCS between April 2019 and July 2023. Interventions Participants were randomized to 4 vs 8 counseling sessions, 2 vs 8 weeks of nicotine replacement therapy (NRT), and screening for social determinants of health (SDH) vs no screening. Main Outcomes and Measures The primary effectiveness outcome was self-reported 7-day smoking abstinence at 6 months. Cost measures included both start-up and operating costs, with incremental cost per quit (ICQ) calculated relative to usual care. Results Screen ASSIST had 642 participants (mean SD age, 64. 0 6. 5 years; 358 female 55. 8%; mean SD 36. 8 19. 4 pack-years; mean SD 16. 2 8. 2 cigarettes per day). Start-up costs for the program were 131 371, primarily for electronic health record programming (124 903). Operating costs for the intervention conditions ranged from 196 272 to 274 865 for 642 participants. The ICQ of 8 counseling sessions, 2 weeks NRT, and no SDH screening was 3050 (95% CI, 1286-4815), the most cost-effective condition. Per-patient costs and ICQ would be lower in health systems serving larger patient populations. Conclusions and Relevance In this economic evaluation of smoking cessation treatment in LCS, 8-session counseling combined with 2 weeks of NRT was a cost-effective strategy, with a favorable ICQ relative to usual care and other treatment strategies evaluated. These findings are relevant for health systems considering integrating smoking cessation programs with LCS services.