Cost-Effectiveness of Smoking Cessation Interventions Integrated Into Lung Cancer Screening

Importance National-level data are limited on the long-term costs and outcomes of integrating smoking cessation interventions into lung cancer screening (LCS) programs in the US. Objective To evaluate the cost-effectiveness of smoking cessation interventions in LCS using data from 4 randomized clinical trials implemented within the National Cancer Institute’s Smoking Cessation at Lung Examination (SCALE) Collaboration. Design, Setting, and Participants In this economic evaluation, data were pooled from individuals enrolled across 23 arms in 4 SCALE trials from October 2016 to April 2023. Included participants were eligible for LCS and currently smoked. Data were analyzed from May 2025 to June 2026. Exposures LCS with and without cessation interventions. The 23 arms were classified into 8 composite treatment classes based on low, moderate, and high intensities of pharmacotherapy and counseling. Main Outcomes and Measures From a societal perspective, cost per quit was estimated during trial follow-up periods and incremental cost-effectiveness ratios over a lifetime horizon. Intervention costs were micro-costed at steady state. Trial data were extended to a lifetime horizon using an established lung cancer microsimulation model. Costs and quality-adjusted life-years (QALYs) were discounted at 3%. Sensitivity analyses tested the estimated effects of varying quit rates, costs, background cessation rates, relapse, and screening uptake and adherence. Results Of 2520 participants (mean [SD] age, 63.8 [5.8] years), 1278 (50.7%) were male. Mean (range) treatment class costs varied from $38.96 ($2.43-$57.45) to $803.10 ($563.18-$1212.73) per participant, with self-reported quit rates ranging from a mean (range) of 10.1% (8.0%-13.0%) to 27.3% (19.5%-31.4%). The lowest-intensity treatment class had the lowest cost per quit at $329.85, whereas the highest-intensity treatment class had the highest at $2945.35. Model projections suggested that the high-intensity pharmacotherapy and low-intensity counseling treatment class yielded the lowest lifetime costs ($1.54 billion per 100 000 screen-eligible population) and the second-highest QALYs (2.26 billion years per 100 000 screen-eligible population). The highest-intensity treatment class achieved the highest QALYs, at an incremental cost-effectiveness ratio of $991.15 per QALY. Compared with screening alone, joint cessation and screening programs were cost-saving. Results were robust across sensitivity analysis scenarios. Conclusions and Relevance In this economic evaluation of integrating smoking cessation interventions in LCS, joint cessation and screening programs were associated with substantial health benefits and favorable cost-effectiveness. These findings may be useful for health systems to guide decisions, while considering budget and capacity, on the modality and intensity of cessation interventions to adopt.