Smoking Cessation With Lung Cancer Screening May Lower Lifetime Costs

Adding smoking cessation treatment to lung cancer screening was projected to lower lifetime costs and improve health outcomes compared with screening alone, according to an economic evaluation published in JAMA Network Open. The most intensive medication and counseling combination produced the largest modeled health gains.

Investigators pooled data from 2,520 adults who smoked and were eligible for screening across 23 intervention arms in four randomized trials. The arms were grouped into eight classes by pharmacotherapy duration and counseling intensity. A microsimulation model projected lifetime costs and quality-adjusted life-years (QALYs) from a societal perspective, with costs and QALYs discounted at 3%. The trials lacked a no-intervention control group, so background quit rates came from national survey data.

Mean intervention costs ranged from $38.96 to $803.10 per participant, and mean self-reported quit rates ranged from 10.1% to 27.3%. Quitting was assessed as seven-day abstinence at six months in three trials and 12 months in one. The lowest-intensity combination had the lowest short-term cost per quit, $329.85. Costs were expressed in 2025 US dollars.

High-intensity pharmacotherapy with low-intensity counseling generated the lowest projected lifetime costs. The highest-intensity combination yielded additional modeled health gains at $991.15 per QALY compared with that strategy. High intensity meant more than eight weeks of pharmacotherapy and more than 82 minutes of counseling; low-intensity counseling involved less than 60 minutes or educational materials alone.

The base-case model assumed 100% screening uptake, adherence, and cessation participation. Investigators cautioned that self-reported quitting could overestimate abstinence and that relapse was not explicitly modeled. Sensitivity analyses incorporating a 50% reduction in quit rates did not change the conclusions.

Source: Cao P, Smith L, Tian E, et al. Cost-effectiveness of smoking cessation interventions integrated into lung cancer screening. JAMA Netw Open. 2026;9(9):e2633630. doi:10.1001/jamanetworkopen.2026.33630