Survival and Economic Benefits of Implementing Evidence-Based Tobacco Treatment Across US Cancer Care

Continued smoking after a cancer diagnosis worsens survival and increases health care costs. We projected the 10-year survival gains and health care cost savings associated with nationwide implementation of evidence-based tobacco treatment for US patients with cancer and survivors.

We developed a population-based dynamic survival and cost model including 18 million US cancer survivors, assuming 11.4% smoking prevalence, and 2 million annual incident cancer cases, assuming 15% smoking prevalence. The model tracked annual transitions among smoking, abstinence, relapse, survival, and death over 10 years, using proportional hazards survival mapping, explicit relapse dynamics, and 3% annual cost discounting. The primary comprehensive program scenario assumed 50% program reach, 45% abstinence among reached patients, a mortality hazard ratio of 0.79 for abstainers versus continuing smokers, and 20% annual relapse. Implementation scenarios and probabilistic sensitivity analyses were evaluated.

The comprehensive program scenario was projected to prevent 66,462 deaths and yield 287,446 life-years gained over 10 years, with $12.32 billion US dollars (USD) in present-value (PV) health care cost savings. In probabilistic sensitivity analysis with 10,000 simulations, mean outcomes were 66,542 lives saved (95% uncertainty interval [UI], 28,394 to 116,297) and $12.38 billion USD in PV cost savings (95% UI, $6.95 to $20.69 billion USD). An enhanced implementation scenario with 80% reach and 60% abstinence was projected to prevent 141,785 deaths, yield 613,219 life-years gained, and save $26.28 billion USD. Reach, abstinence, and relapse were the primary drivers of survival and economic value. The break-even program cost per participant was approximately $5,255 USD.

National implementation of evidence-based tobacco treatment in cancer care could save tens of thousands of lives and substantially reduce health care costs within 10 years.