Study Explores Most Cost-Effective Smoking Cessation Methods in Lung Cancer Screening
•February 11, 2026
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Why It Matters
The findings give health systems concrete data to align guideline‑recommended cessation services with financial sustainability, accelerating integration into lung‑cancer‑screening pathways.
Key Takeaways
- •Eight telehealth sessions + 2‑week NRT cost $3,050 per quit.
- •Startup EHR programming cost $131k, dominates initial expenses.
- •Operating costs $196k‑$275k, improve with higher patient volume.
- •No social‑determinants screening needed for most cost‑effective strategy.
- •Findings guide health systems on affordable cessation integration.
Pulse Analysis
Integrating smoking‑cessation services into lung‑cancer‑screening programs has long been a clinical priority, but health‑system leaders often wrestle with the economics of implementation. This study provides a granular cost‑effectiveness framework, separating fixed start‑up investments—chiefly electronic‑health‑record (EHR) algorithms for patient identification—from variable operating expenses such as counseling staff time and nicotine‑replacement therapy (NRT). By quantifying the incremental cost per quit at $3,050, the analysis offers a benchmark that can be compared against other preventive interventions, helping administrators justify budget allocations and negotiate payer contracts.
The research also highlights economies of scale that become apparent as screening volumes rise. Larger health systems can dilute the $131,371 start‑up outlay across more patients, driving down per‑quit costs and making intensive counseling models financially viable. This insight is especially relevant for integrated delivery networks and accountable care organizations that aim to meet US Preventive Services Task Force recommendations while maintaining cost containment. Moreover, the study’s sensitivity analyses underscore the importance of local factors—EHR readiness, wage structures, and payer mix—in shaping real‑world affordability, prompting institutions to tailor rollout strategies to their operational context.
Beyond the immediate financial calculus, the findings have broader implications for public health outcomes. Effective cessation during the screening window can reduce smoking‑related morbidity, lower downstream cancer treatment costs, and improve overall survival rates. As policymakers consider incentive programs and value‑based reimbursement models, evidence of a low‑cost, high‑impact cessation pathway strengthens the case for mandatory integration of these services into lung‑cancer‑screening protocols. Health systems that act now can position themselves as leaders in preventive care while reaping long‑term economic and clinical benefits.
Study explores most cost-effective smoking cessation methods in lung cancer screening
Patricia Weiser, Pharm.D.
February 11, 2026
Key Takeaways
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Eight telehealth counseling sessions plus two weeks of nicotine patches produced the most favorable incremental cost per quit ($3,050; 95 % CI, $1,286–$4,815) versus usual care.
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Intervention permutations varied counseling dose (four vs eight sessions), NRT duration (two vs eight weeks), and social‑determinants screening with referral, enabling comparative cost‑effectiveness within screening workflows.
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Start‑up costs were substantial ($131,371) and largely driven by EHR programming to identify eligible smokers, exceeding direct counseling or NRT costs.
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Operating costs ranged $196,272–$274,865, with sensitivity analyses indicating economies of scale as lung‑cancer‑screening volume increases.
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Real‑world affordability hinges on local EHR readiness, wage structure, payer arrangements, and screening throughput when integrating guideline‑concordant cessation services.
A new economic evaluation finds that pairing extended counseling with a brief course of nicotine replacement therapy offers the best value for health systems integrating smoking cessation into lung cancer screening.
Mass General researchers investigated the most cost‑effective way to encourage people to stop smoking as part of a lung‑cancer‑screening program. A streamlined combination of intensive counseling and short‑term nicotine replacement therapy appears to offer health systems the best value for helping patients quit smoking during lung‑cancer screening, according to an economic evaluation published last month in JAMA Network Open by researchers at the Mongan Institute Health Policy Research Center at Massachusetts General Hospital in Boston. Among eight smoking‑cessation strategies tested, eight sessions of counseling delivered by telehealth combined with two weeks of nicotine replacement therapy emerged as the most cost‑effective approach.
Smoking cessation is a central component of lung‑cancer‑screening programs, given the strong link between tobacco use and lung‑cancer outcomes. Tobacco smoking accounts for approximately 80 % of lung‑cancer deaths, and current US Preventive Services Task Force recommendations advise that people eligible for lung‑cancer screening should also be offered smoking‑cessation services. Although multiple cessation approaches have demonstrated effectiveness, less is known about how their costs compare when implemented within screening programs.
Douglas Levy, Ph.D., a researcher at MGH in Boston, led a study examining the cost‑effectiveness of smoking‑cessation programs that are associated with lung‑cancer screening.
To address that gap, a team of investigators led by Douglas E. Levy, Ph.D., associate professor at Harvard Medical School, conducted a pre‑planned economic evaluation of the Screen Aiding Screening Support In Stopping Tobacco (ASSIST) trial. The trial was conducted at 11 lung‑cancer‑screening sites within a single Massachusetts health system and enrolled patients who smoked and were scheduled for lung‑cancer screening between April 2019 and July 2023. The analysis included 642 participants with an average age of 64 years.
The Screen ASSIST trial tested eight combinations of smoking‑cessation interventions. Participants were randomized to receive either four or eight behavioral counseling sessions, two or eight weeks of free nicotine‑replacement‑therapy patches, and either screening or no screening for adverse social determinants of health with referral to community services when needed. The primary effectiveness outcome was self‑reported seven‑day smoking abstinence at six months.
From a health‑system perspective, researchers prospectively assessed start‑up and operating costs and calculated incremental cost per quit relative to usual care. Total start‑up costs reached $131,371, largely driven by electronic‑health‑record programming needed to identify eligible patients. Operating costs across intervention conditions ranged from $196,272 to $274,865.
The most cost‑effective strategy was eight counseling sessions combined with two weeks of nicotine‑replacement therapy and no screening for social determinants of health. This approach yielded an incremental cost per quit of $3,050, with a 95 % confidence interval of $1,286 to $4,815. Sensitivity analyses suggested that per‑patient costs and incremental cost per quit would be lower in health systems serving larger patient populations.
“Guidelines recommend that folks eligible for lung cancer screening (LCS), who are still using tobacco, be offered smoking cessation services,” Levy says. “Healthcare systems working to adhere to these guidelines want to know not only which strategies work to help people quit, but also which strategies are affordable to operate.”
Levy adds that “a program of intensive counseling (8 sessions over 12 weeks) and a starter course of nicotine replacement therapy (2 weeks’ worth of patches) was both the most effective and the most cost‑effective strategy to help LCS patients quit smoking.”
According to Levy, the single most expensive line item was neither the counseling nor nicotine replacement therapy, but setting up the computer system needed to identify eligible patients. That cost would be lower for health systems that already have computerized ways of spotting candidates for smoking cessation in place.
“Costs will also be lower for systems with larger volumes of LCS patients using tobacco, as that spreads the fixed costs over a larger group of people,” he adds.
The authors emphasize that local context will shape real‑world costs, particularly electronic‑health‑record capabilities, payment models, wage variation and screening volume. Still, the findings may help healthcare systems make more informed decisions as they work to integrate effective and sustainable smoking‑cessation services into lung‑cancer‑screening workflows.
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