Within a smoking-cessation program, what impact does genetic information on lung cancer need to have to demonstrate cost-effectiveness?

Table 1 Data parameters used in model: description, base case estimate, range tested in one-way sensitivity analyses and sources

Parameter description	Base estimate	Range tested	Sources
Quit rates: 12-month continuous abstinence
a) Genetic Test	11%	7-22%	[12]
b) Usual treatment	6%	3-12%	[17]
Relapse rate after 12-month quit	10% in years 2-6, 4% after¹		[15]
Lung cancer incidence	Annual from age 40, e.g., 0.0018024 at age 65 years¹		[32]
Relative risk of lung cancer in heavy smokers compared to general population	6.609 and		[18]
Relative risk of lung cancer in ex-smokers compared to general population	Annual from 5-year age group by time since quit e.g, ages 50-55 years RR = 4.75¹
Survival/mortality rates (background population)	Annual by age e.g, age 65 annual dying rate = 0.00936¹		ABS Life Tables 2005-07²
Survival rates of lung cancer	Annual survival at 1 year 36% to 12% at 5 years		AIHW [33]
Proportion of
a) early lung cancer	20%	13-23%	[33], authors assumption³
b) adv lung cancer	80%	77-87%
Utility scores
a) Early stage lung cancer (I&II)	0.73	0.69-0.83	[23, 34]
b) Adv stage lung cancer (III&IV)	0.66	0.30-0.76	[23, 34]
c) No lung cancer	1	-	authors assumption
Lung cancer healthcare costs
a) Early lung cancer 1st year (NSCLC only)	44,274		[35, 36]
b) Adv lung cancer + SCLC 1^st year	27,057	All ± 30%	[35, 36]
c) Ongoing costs (stable disease)	7,115		[36, 37]
d) Progressive disease	10,945		[36, 37]
e) Terminal care (final year)	9,961		[36, 37]

1. Tables are used rather than one point estimate to account for different values that change over time. Values will alter when individuals age.
2. Epidemiological data and cost data are from slightly different years; data from these life-tables are from 2005-2007 while costs in 2009 AU$.
3. A proportion of approx. 8% of lung cancers are 'unstaged' but to avoid losing these people in the model, the proportion unstaged was assumed to be equally split into early and advanced disease groups.
Abbreviations: ABS - Australian Bureau of Statistics, AIHW - Australian Institute of Health and Welfare, NSCLC - non-small cell lung cancer, SCLC - small cell lung cancer.

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