Economic and health impact of integrating smoking cessation services into NHS cancer care pathways in England: a modelling study.

Background: Research has shown that smoking post-diagnosis negatively impacts cancer outcomes. This study aimed to assess the health and cost impacts of introducing smoking cessation services at cancer diagnosis for people who smoke. Methods: A cost-effectiveness model was developed using a UK National Health Service (NHS) and Personal Social Services perspective. A partitioned survival model was built and survival analysis was used to estimate the proportion of the cohort in each health state (progression-free, progressed and dead) based on smoking status. Four populations were explored: lung cancer (stage 1-3a), head and neck cancer (stage 3-4), kidney cancer, and general cancer. Findings: Over a lifetime time horizon, offering smoking cessation at diagnosis resulted in an incremental cost-effectiveness ratio of £2606, £5495 and £4055 per quality-adjusted life-year (QALY), for lung, head and neck, and general cancer, respectively. The intervention was dominant for kidney cancer. Offering smoking cessation extended life by 2-8 months and slowed cancer progression by 2-6 months. Interpretation: This analysis indicates that implementing smoking cessation into NHS cancer care is cost effective at a £20,000 per QALY willingness-to-pay threshold, and provides large health benefits. Smoking cessation aligns with the NHS 10-year plan to move from treating sickness to preventing illnesses. Funding: This study was funded by the Manchester Foundation Trust.