IN lung cancer screening eight-session counseling with short-course nicotine replacement therapy delivered the best value per quit.
Smoking Cessation in Lung Cancer Screening: What Was Studied
Integrating smoking cessation services into lung cancer screening programs could reduce smoking-related illness, but health systems need clarity on affordability and value. Investigators evaluated the costs and cost-effectiveness of eight tobacco treatment strategies tested in the Screen ASSIST trial, conducted across 11 lung cancer screening sites within a large Massachusetts health system.
The study enrolled English-speaking and Spanish-speaking adults who smoked and were scheduled for lung cancer screening between April 2019 and July 2023. Participants were randomized using a three-way factorial design that compared four versus eight counseling sessions, two versus eight weeks of nicotine replacement therapy, and screening for social determinants of health versus no screening. The primary effectiveness outcome was self-reported seven-day smoking abstinence at six months.
Costs and Value Per Quit
A total of 642 participants were included, with a mean age of 64 years and an average smoking history of 36.8 pack-years. From a health system perspective, the program’s start-up costs were $131,371, driven largely by electronic health record programming. Operating costs across intervention conditions ranged from $196,272 to $274,865 for the full participant group.
To compare strategies, the authors calculated incremental cost per quit relative to usual care. The most cost-effective combination was eight counseling sessions paired with two weeks of nicotine replacement therapy and no social determinants of health screening. This approach had an incremental cost per quit of $3,050, with a reported 95% confidence interval of $1,286 to $4,815.
Why These Findings Matter for Health Systems
The authors noted that per-patient costs and incremental cost per quit would likely be lower in health systems serving larger patient populations, suggesting potential efficiencies with scale. Overall, the results support smoking cessation in lung cancer screening as a feasible, cost-effective approach when delivered as higher-intensity counseling with a shorter nicotine replacement therapy course.
Reference: Levy DE et al. Economic Evaluation of Tobacco Treatments From the Screen ASSIST Lung Cancer Screening Trial. JAMA Netw Open. 2026;9(1):e2555332.
