Presentation (CTI)

OBJECTIVES: Lung cancer is the most common cause of cancer-related deaths worldwide. The English Lung Cancer Screening (LCS) programme invites people aged 55-74 who either smoke or used to smoke for a screening test. Integrating smoking cessation support into LCS may optimise cessation services compared with a central referral service. Recent evidence suggests this would be a cost-effective approach in England. However, limited evidence is available on the equity impact. The objective of this analysis is to determine the equity impact of providing smoking cessation as part of LCS.
METHODS: To evaluate the cost-effectiveness of redefining smoking cessation service delivery, we used a Markov model, adapted from previous National Institute for Health and Care Excellence guidelines. We then applied an aggregate distributional cost-effectiveness analysis (DCEA) framework to assess the impact on equity. This approach focuses on inequalities generated by socioeconomic differences in healthcare need and utilisation. Outcomes from the cost-effectiveness model were combined with data on the size and socioeconomic distribution of the study populations to estimate changes in inequality. A cost-effectiveness threshold of £20,000 per QALY was used to convert costs into health opportunity costs. Equity impacts were calculated using the Atkinson index and expressed in QALYs. Extensive scenario analysis was undertaken.
RESULTS: Under all base case assumptions, smoking cessation provided as part of targeted LCS had a positive net health benefit and equity impact, regardless of the intervention. Approximately three times more QALYs were generated in the most deprived compared with the least deprived. The analysis was sensitive to uptake, with unequal uptake potentially worsening inequalities. Scenario analyses supported a likely positive equity impact.
CONCLUSIONS: Reforming smoking cessation services as part of LCS would likely improve population health and equity. Uptake is a key determinant. A DCEA framework highlights the importance of implementation strategies in reducing health inequalities.