Smoking cessation with screening saves costs

Adding smoking cessation support to lung cancer screening improved health outcomes and lowered projected lifetime costs.
*Economic evaluation using randomized trial data and modeling; Level 2.

Citation

Cao P, Smith L, Tian E, et al. Cost-Effectiveness of Smoking Cessation Interventions Integrated Into Lung Cancer Screening. JAMA Network Open. 2026;9(9):e2633630. doi:10.1001/jamanetworkopen.2026.33630

Background

Many adults eligible for lung cancer screening still smoke, creating an opportunity to combine screening with quit support. The best intensity of medication and counseling support is uncertain.

Patients

2520 U.S. adults in 4 randomized trials who currently smoked and were eligible for lung cancer screening. People not eligible for screening or not currently smoking were not included.

Intervention

Lung cancer screening plus smoking cessation programs with varying medication duration and counseling intensity.

Control

Lung cancer screening alone, modeled using external background quit rates.

Outcome

Cost per quit, lifetime costs, and quality-adjusted life-years, a measure combining survival and health quality.

Follow-up Period

Quit outcomes at 6 months, except one 12-month trial; lifetime modeled projection.

Results

Strategy Quit rate Cost per quit Lifetime finding per 100,000 eligible people
Low medication + low counseling 11.8% $330 Lowest short-term cost per quit
High medication + low counseling 22.5% $1424 Lowest projected lifetime cost: $1.54 billion
High medication + high counseling 27.3% $2945 Highest health gain; $991 per quality-adjusted life-year (CI not reported)
Screening alone Background only — Higher costs and fewer health gains than all combined strategies

Results were modeled from a societal perspective. Screening plus cessation was cost-saving versus screening alone. The available current control was screening without a structured cessation intervention.

Limitations

Quit rates were self-reported. Long-term outcomes were modeled, not observed. Trials lacked a no-intervention control group. Relapse and participation rates required assumptions. Benefits may be underestimated because non-cancer smoking harms were not fully counted.

Funding

U.S. government grants; funders reported no role.

Clinical Application

Integrate evidence-based quit support into lung cancer screening; choose intensity based on resources, favoring medication access when feasible.