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Behavioral Smoking Cessation Intervention Shows Strong Cost-Effectiveness at 12 Months in Cervical Cancer Survivors
A cost-effectiveness analysis of a randomized trial found that the MAPS behavioral smoking cessation intervention cost just $921 per additional quit compared to standard treatment at 12 months, with near-certain cost-effectiveness (approximately 100% probability) at a societal willingness-to-pay threshold of $10,000 per quit. However, this advantage weakened substantially by 18 months, where cost-effectiveness probability fell to 52%, driven largely by outcome attenuation among participants with low engagement.
What Was Studied
This study evaluated whether a structured behavioral smoking cessation program—motivation and problem-solving (MAPS)—represents good value relative to standard treatment (ST) when delivered to patients with a history of cervical intraepithelial neoplasia or cervical cancer. Understanding the economic value of such interventions is critical for justifying their adoption within cancer center settings, where resources are limited and competing priorities are common.
How It Was Studied
The analysis used data from a prospective randomized clinical trial conducted between February 2017 and January 2020, with follow-up extending to August 2021 and economic analysis completed between January 2024 and December 2025. A total of 194 participants were included—98 randomized to MAPS and 96 to standard treatment. MAPS consisted of up to six individual counseling sessions delivered over 12 months, focusing on smoking cessation, relapse prevention, and individualized support for life stressors. Cost-effectiveness was assessed from the perspective of cancer centers using both deterministic analysis (reported as an incremental cost-effectiveness ratio, or ICER) and probabilistic analysis (reported as a cost-effectiveness acceptability curve), with the primary outcome being 7-day point prevalence abstinence measured at months 12 and 18.
What Was Observed
- MAPS participants had meaningfully higher abstinence than standard treatment participants at 12 months—26.5% versus 12.5%—representing a more than twofold difference in quit rates. This differential underpins the strong cost-effectiveness finding at that time point.
- The incremental cost per additional quitter was $921 for MAPS versus ST at month 12, rising sharply to $7,458 per quit at month 18 in the deterministic analysis. This increase reflects a narrowing of the abstinence gap over time rather than a rise in intervention costs, which were $522.74 per MAPS participant versus $389.26 for ST (95% CI, $500.19–$545.29 and $362.67–$415.84, respectively).
- In the probabilistic analysis at a societal willingness-to-pay of $10,000 per quit, MAPS was cost-effective with nearly 100% probability at month 12, but only 52% probability at month 18—indicating genuine uncertainty about sustained value beyond the first year.
- Subgroup analysis showed that participants with high MAPS engagement (four or more sessions) maintained a lower ICER even at 18 months, and sustained 7-day abstinence rates despite the overall decline seen in the full trial population. Participants receiving fewer than four sessions drove the attenuation of benefit over time.
Why This Matters
Smoking cessation is a modifiable risk factor particularly relevant in cervical cancer and precancerous disease, where tobacco use is associated with disease progression and recurrence. Establishing the economic case for behavioral cessation programs within oncology settings fills a notable evidence gap, as cost-effectiveness data for this specific population have been lacking. The engagement-dependent findings also provide a practically important signal: the value of this intervention appears closely tied to dose received, which has implications for how future programs might be structured or prioritized.
How to Read This Result
While the short-term cost-effectiveness evidence is compelling, the findings are drawn from a relatively small trial (194 participants) conducted at cancer centers, which may limit generalizability to other healthcare settings or populations with different baseline smoking characteristics.
Limitations
The abstract does not explicitly report study limitations beyond the attenuation of intervention effectiveness over time among low-engagement participants, and the analysis was conducted solely from the perspective of cancer centers, potentially excluding broader societal cost dimensions such as productivity losses or out-of-pocket patient expenses.