Cost effectiveness of adding smoking cessation to lung health check programmes

Abstract

Background: Smoking impacts smokers and those around them because it is associated with higher risks of many diseases and mortality. This makes it one of the most important modifiable risk factors that can be targeted by health care authorities. In the United Kingdom, the lung health check programme is mainly concerned with screening smokers for lung cancer. The all-smoker population of the programme represents an avenue for encouraging quitting by utilising available interventions. Objective: To examine the cost effectiveness of varenicline, a smoking cessation intervention, compared to no intervention in the context of the targeted lung health check programme for people between the ages of 55 and 75 years from the perspective of the National Health Service. Methods: A cohort Markov model for smokers, former smokers, and non-smokers is constructed with a lifetime horizon to calculate the costs and benefits. UK costs and utilities are used for the intervention and prominent comorbidities. The model draws on age, sex, and smoking-status data to calculate prevalence of the most common comorbidities and mortality. Results: Varenicline resulted in a cost-effective incremental cost-effectiveness ratio of £1151 per quality-adjusted life year (QALY). The intervention remained cost effective in an alternative scenario using evidence from another trial. Sensitivity analyses showed the estimated intervention effect has a higher impact on results than costs. Conclusion: The addition of smoking cessation pharmacologic intervention to the lung health check programmes is likely to improve health and reduce costs to the NHS, although the model findings are limited by lack of efficacy data focused on the full range of the targeted age group.