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.