Cost-effectiveness and budgetary impact of three preventive strategies in lung cancer


The prevalence of smoking in Spain is declining; however, both the incidence and mortality from lung cancer are increasing alarmingly among women and the trend is expected to continue to increase if no intervention is taken. In a general context of cost containment, health interventions should not only be evaluated in terms of health impact or in economic terms, but also in terms of efficiency.


  1. To define and estimate the Spanish population at high risk of developing lung cancer.
  2. To determine the proportion of the population attended in Primary Health Care with a high risk of developing lung cancer.
  3. To carry out an economic evaluation comparing the implementation of three preventive strategies in lung cancer with a no-intervention scenario, from the perspective of the National Health System (NHS) and from the social perspective. Cost-utility analysis is contemplated to measure health benefits as quality-adjusted life years, and cost-effectiveness analysis to measure health benefits as avoidable deaths from lung cancer.
  4. To analyse the budgetary impact of the implementation of three preventive strategies in lung cancer in the NHS.


Objective 1: The data from the Spanish National Health Survey (ENSE) 2011-12 are used. The population at risk is described throughout the Spanish territory and stratified by sex and autonomous community.

Objective 2: The electronic medical record of Primary Health Care is explored. The assigned population and the population served at the Health Region of Barcelona are selected considering two age groups: 35-49 years (potentially at risk) and 50-75 years (high risk). The results are compared with the theoretical proportion obtained with the ENSE and confidence intervals of proportions are used to estimate statistically significant differences between both groups.

Objective 3: A hypothetical cohort with the characteristics of the adult population at high risk of developing lung cancer and the population potentially at risk is studied using the data from ENSE 2011-12. Primary and secondary prevention interventions applied to high-risk and potentially-at-risk population groups are combined: brief smoking cessation intervention, intensive smoking cessation intervention and organized screening. In order to determine the efficacy of each of the interventions, a systematic review of the literature is carried out to obtain different percentages of quitting smoking. The baseline scenario (no intervention) is compared with three preventive strategies, combining primary and secondary prevention interventions applied to both population groups.

Objective 4: The population at risk calculated from ENSE 2011-12 is considered. Two scenarios are estimated and compared, the current scenario and new hypothetical scenarios derived from the introduction of the different strategies, considering different percentages of implementation of such interventions.


1 year, extended by 6 months (January 2017 to June 2018).


Grants for cancer research projects, Spanish Association Against Cancer, AECC (€35,000).

Research team

Llúcia Benito (ICO-IDIBELL)

Gemma Binefa (ICO-IDIBELL)

Misericòrdia Carles (URV)

Julieta Corral (ICO-IDIBELL)

Mireia Díaz (ICO-IDIBELL)

Esteve Fernández (ICO-IDIBELL)

Marcela Fu (IP, ICO-IDIBELL)

Montse García (IP, ICO-IDIBELL)

Carlos Martín (CAP Passeig de Sant Joan)

Amparo Romaguera (ICO)

Albert Santiago (ICO-IDIBELL)

Carmen Vidal (ICO-IDIBELL)

Montserrat Rué (IRB Lleida)

Marta Trapero-Bertran (UIC)