Purpose <p>Budget impact analyses (BIAs) aim to estimate costs of evidence-based programs in specific contexts, an important component of implementation decision making. We developed a BIA tool focused on the Smokefree Support Study, a cost-effective smoking cessation program for patients entering cancer care and refined the tool through usability testing.</p> Methods <p>The BIA tool was structured using data from the Smokefree Support Study cost-effectiveness study. We refined the tool via usability testing to improve functionality and gain insight into the tool’s potential for informing adoption decisions. We recruited participants from sites participating in the NCI-funded Cancer Center Cessation Initiative.</p> Results <p>The final BIA tool allowed users generate context-specific cost estimates. Usability testing interviews informed changes to improve the BIA tool’s usability and also illustrated users’ natural inclination toward adaptation, helped identify the target audience for the tool, and underscored that cost results should be contextualized with other decision criteria to support program adoption.</p> Conclusion <p>We developed a BIA tool with which users can generate context-specific cost estimates of the Smokefree Support Study program. The breadth of usability feedback provided by participants and perspectives on using the BIA tool underscore the importance of involving end users in the development of tools and products.</p>