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.