Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients

Round 1

Reviewer 1 Report

The study aim is important, but there are several major concerns regarding this study.

1. Methods used in this study are unclear. The authors stated that this is original research, however, this study looks like a narrative review.

2. The Abstract is very limited and too short. Please provide comprehensive abstract.

3. Introduction section is unclear. Lines 24-27? Where should it be placed? Moreover, the introduction is very limited. Please provide a comprehensive overview and justification for this topic.

4. The methods section - please provide structured, logical methods in line with scientific standards (see Instruction for Authors).

5. It is unclear how the results match with methods and objectives. These results look like subjective choice made by the authors rather than logical flow. 

6. Please add 2-3 practical implications of this study.

Author Response

Review #1 Comments

1. Methods used in this study are unclear. The authors stated that this is original research, however, this study looks like a narrative review.

We have addressed this comment by clarifying the type of study with the following text, "This paper shares lessons about the cost-effectiveness of SCPs for cancer patients by exploring insights from a generic economic evaluation model as well as reviewing findings from the scientific literature to inform model assumptions."

2. The Abstract is very limited and too short. Please provide comprehensive abstract.

To address this comment, we have added information in the results and conclusion summaries of the abstract.

3. Introduction section is unclear. Lines 24-27? Where should it be placed? Moreover, the introduction is very limited. Please provide a comprehensive overview and justification for this topic.

This was a stylistic choice but now we removed the quote from the paper.To address the comment, we have added context at the beginning of the introduction in the form of a new paragraph, which further provides an overview of the importance of this paper and its subject matter. Several sentences and edits have been added throughout the introduction to provide a more comprehensive overview and justification.

4. The methods section - please provide structured, logical methods in line with scientific standards (see Instruction for Authors).

Our research team has reviewed the Instruction for Authors page and confirmed we have followed the formatting and content guidelines.

5. It is unclear how the results match with methods and objectives. These results look like subjective choice made by the authors rather than logical flow. 

We have included a few sentences to begin the Results section clarifying how the Results match the objectives and methods.

6. Please add 2-3 practical implications of this study.

Practical implications include

1) SCPs appear effective at helping patients quit smoking and this may increase the effectiveness of treatment.

2) The extra costs from SCPs appear reasonable.

3) SCPs for cancer patients may be one of the most cost-effective interventions for cancer patients, and real-world studies of the cost-effectiveness of SCPs are needed to provide location-specific information.

Reviewer 2 Report

This manuscript examines the cost-effectiveness of smoking cessation programs for patients with cancer. While this is an important topic for consideration, the analysis, results, and discussion do not tie together well, leaving the reader feeling somewhat disjointed. The analytical choices made in the run-up to the systematic review of the literature dampen enthusiasm for the final result.

Specific comments:

The Introduction is well-written and comprehensive.

Line 68: This is the first time the MOH acronym is used. Please spell out.

Line 74: This seems like an odd explanation of a societal perspective for the cost-effectiveness analysis. If it is a societal perspective, why not just call it that? Doesn’t the Minister of Health care about the total cost to society?

Line 77: This seems like a long-winded explanation of why QALYs are the best outcome to use in a CEA, followed by a brief statement that QALYs won’t be used for this paper. Instead, there will be an amorphous ‘better off’ outcome used.

Line 92: Again, there is an explanation of why a specific time frame should be stipulated for the analysis, followed by a statement that this paper won’t be using a specific time frame.

Line 100: I’m assuming there is some typo in the line and that the probability of quitting without a SCP is denoted with a different Y symbol.

Line 204: Figures 4 and 5 are interesting, but they don’t seem to have anything to do with the rather long-winded discussion of ‘better off’ from section 3.1.

Line 272: This seems like an important paragraph, but it comes out of nowhere and doesn’t seem to be connected to the explanation of either the methods or results of the paper up to this point.

Line 286: Again, while this paragraph provides an important perspective for consideration, it doesn’t seem to be connected to the preceding methods or results sections.

Author Response

Review #2 Comments

(1) The Introduction is well-written and comprehensive.

Thank you very much!

(2) Line 68: This is the first time the MOH acronym is used. Please spell out.

Thank you for drawing this to our attention. We have spelled out the acronym at this location.

(3) Line 74: This seems like an odd explanation of a societal perspective for the cost-effectiveness analysis. If it is a societal perspective, why not just call it that? Doesn’t the Minister of Health care about the total cost to society?

We have removed the example of what MOH does not cover, so as to alleviate any confusion.

(4) Line 77: This seems like a long-winded explanation of why QALYs are the best outcome to use in a CEA, followed by a brief statement that QALYs won’t be used for this paper. Instead, there will be an amorphous ‘better off’ outcome used.

We added content to the end of this paragraph to clear up any potential confusion around what "better" represents and how this applies to LYs and QALYs.

(5) Line 92: Again, there is an explanation of why a specific time frame should be stipulated for the analysis, followed by a statement that this paper won’t be using a specific time frame.

We have also added to the end of this paragraph to clarify how a time-horizon can be selected and applied based on the researcher/funders needs.

(6) Line 100: I’m assuming there is some typo in the line and that the probability of quitting without a SCP is denoted with a different Y symbol.

Thank you! We have fixed this typo.

(7) Line 204: Figures 4 and 5 are interesting, but they don’t seem to have anything to do with the rather long-winded discussion of ‘better off’ from section 3.1.

Thank you, we have added to the start of this section a description of how these data can inform the reader's own model.

(8) Line 272: This seems like an important paragraph, but it comes out of nowhere and doesn’t seem to be connected to the explanation of either the methods or results of the paper up to this point.

We have connected the two paragraphs with a new concluding sentence in paragraph 1. Paragraph 1 begins with "Based on our literature search we found evidence suggesting that it is likely neither Delta E1 nor Delta E2 is zero." Paragraph 1 ends with the new sentence which introduces paragraph 2 discussing delta E2.

(9) Line 286: Again, while this paragraph provides an important perspective for consideration, it doesn’t seem to be connected to the preceding methods or results sections.

We have labeled to sections to clarify which discuss effectiveness, cost and cost-effectiveness.

Round 2

Reviewer 1 Report

The Authors addressed all the comments.

However, please provide a more informative abstract. The Abstract should be precise and informative, and methods should be underlined, as most of the reader's screen abstracts before the full-text read. This is crucial to increase a visibility and potential impact of this manuscript. 

Author Response

Review 1 would like, "a more informative abstract. The Abstract should be precise and informative, and methods should be underlined, as most of the reader's screen abstracts before the full-text read. This is crucial to increase a visibility and potential impact of this manuscript."

We have revised the Abstract to be more informative.

 

 

Reviewer 2 Report

The manuscript is much improved from the original submission.

Author Response

Review 2 wrote, "The manuscript is much improved from the original submission."

We appreciate the comment.