Cancer patients who continue to smoke cost the healthcare system billions of dollars annually, thanks to smoking’s contribution to first-line treatment failures, a modeling study found.
The model estimated the cost of continuing to smoke to be nearly $11,000 per patient in treatment costs after failure of the initial cancer treatment protocol, or $2.1 million per 1,000 cancer patients (smokers and nonsmokers), reported Graham Warren, MD, PhD, of the Medical University of South Carolina in Charleston, and colleagues in
JAMA Network Open.
Multiple variables were used to determine smoking-related costs, including expected first-line treatment failure rates in nonsmoking patients, smoking prevalence, and the cost of cancer treatment after first-line treatment failure.
“We know that smoking is bad for patients undergoing cancer treatment,” Warren told
MedPage Today, citing a
2014 Surgeon General’s report concluding that smoking increases the risk for overall mortality, cancer-related mortality, cancer-treatment toxicity and developing a second primary cancer.
“With the increasing focus on value-based care in the treatment of cancer, we started to think about how to put a cost on this,” he said.
The researchers noted that widely discussed principles for value-based care in cancer include “patient-centered solutions, optimal care, and cost-containment strategies that do not limit patient access or innovation.”
Drug costs have been a focus, but a
recent analysis suggested that many widely used drugs do not meet survival goals.
“Whereas drug cost and efficacy have been the primary focus for considering value in cancer care, relatively little consideration has been given to other potentially modifiable factors that could affect cancer treatment costs, including health behaviors such as smoking,” they wrote.
The model Warren and colleagues developed did not directly quantify the potential financial savings associated with smoking cessation; at this stage, it only addressed the extra costs incurred with treatment failures associated with smoking.
Specifically, using data from the 2014 U.S. Surgeon General’s report, it considered expected failure rates of first-line cancer treatments in nonsmoking patients, smoking prevalence, odds of first-line cancer treatment failure attributed to smoking, and cost of cancer treatment after such failure.
In the model, smoking-attributable failures peaked when expected cure rates among nonsmoking patients were high, in the range of 50% to 65%.
“Under the [2014 Surgeon General report] conditions of a 30% expected treatment failure rate among nonsmoking patients, 20% smoking prevalence, 60% increased risk of failure of first-line cancer treatment, and $100,000 mean added cost of treating a first-line cancer treatment failure, the additional incremental cost per 1,000 total patients was estimated to be $2.1 million, reflecting an additional cost of $10,678 per smoking patient,” the researchers wrote.
They added that extrapolation of the cost to 1.6 million patients in the U.S. with a cancer diagnosis annually “reflects a potential $3.4 billion in incremental costs.”
“By providing estimates across smoking prevalence rates, risk of failure among smokers vs nonsmokers, and expected cure rates, this model may be applied to estimate outcomes across a breadth of potential cancer conditions and their associated costs,” the researchers wrote.
In an
editorial published with the study, Cara Petrucci, MBA, MPH, and Andrew Hyland, PhD, of Roswell Park Comprehensive Cancer Center, Buffalo, New York, wrote that analysis models like the one developed by Warren and colleagues will be more and more relevant as healthcare “is increasingly focused on delivering value-based care that accounts for both clinical effectiveness and cost of treatment.”
“The effects of continued smoking during cancer treatment have been well documented, but resources for smoking cessation services remain inadequate,” they wrote. “Coverage for smoking cessation by insurance companies is limited and tends to disproportionately favor medical interventions, such as smoking cessation medications, compared with evidence-based interventions.”
Because the economic benefits of smoking cessation have been hard to quantify, smoking cessation interventions do not “attract the attention of systems and clinicians who, although concerned with the health of their patients, operate within the constraints of an increasingly tight financial environment,” they added.
“To show the clinical association of smoking with first-line cancer treatment failure in financial terms places continued smoking during cancer treatment alongside surgery and chemotherapy as a significant contributor to cancer treatment costs.”
Researcher Michael Cummings, PhD, reported receiving personal fees from Pfizer during the conduct of the study and receiving personal fees from plaintiff law firms outside the submitted work.
Primary Source
JAMA Network Open
Secondary Source
JAMA Network Open
