Cost-effectiveness analysis of lung cancer screening with low-dose computed tomography in an Iranian high-risk population

Esmaeili, Mansur Haji; Seyednejad, Farshad; Mahboub–Ahari, Alireza; Ameri, Hosein; Abdollahzad, Hadi; Safaei, Naser; Alinezhad, Farbod; Yousefi, Mahmood

doi:10.1177/09691413211018253

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…Our study showed better effect than study in Iran, but was not as good as those conducted in New Zealand, United States, and Canada. In the study of Iran, LDCT was implemented every 3 years and the ICER increased from screening versus no screening was about 3,283.83 US dollars per QALY (34). In studies of New Zealand, United States, and Canada, annual screening was recommended and the corresponding ICER was 24,934.84 US dollars (35), 49,200 to 96,700 US dollars (10), and 33,825 US dollars (11) per QALY, respectively.…”

Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Lung Cancer Screening With Low-Dose CT in Heavy Smokers in China

Yuan

Sun

Wang

et al. 2022

Cancer Prevention Research

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Although lung cancer screening with low-dose CT (LDCT) can reduce lung cancer mortality by 20%, without an appropriate eligibility criteria, it may result in a waste of medical resources and a degree of unnecessary damage to participants' health. This study aims to give the optimal screening strategy in China based on cost-effectiveness analysis on pros and cons of different situations. From the perspective of primary healthcare system, a Markov model was built to simulate LDCT screening of 100,000 heavy smokers (>30 pack years) aged 40 in different situations. Model parameters mainly came from screening programs conducted in China and other countries, official public data, and published literature. Two indicators of primary outcome, incremental cost-effectiveness ratio (ICER) and net health benefits (NHB), were compared with those of no screening. Sensitivity analysis was conducted to evaluate model uncertainties. We defined the optimal strategy as the one with both acceptable cost effectiveness and maximal NHB. Base-case analysis results showed that for all screening strategies, ICERs were less than three times of GDP per capita. As for NHB results, it showed that when the willingness to pay for screening was less than three times of GPD per capita, the largest NHB was obtained in the strategy which started screening at 50 years old and this strategy showed stable performance in univariate and probabilistic sensitivity as well. Prevention Relevance: LDCT screening is cost effective in heavy smokers in China, and the optimal age to start screening is suggested to be 50 years old.

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Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Lung Cancer Screening With Low-Dose CT in Heavy Smokers in China

Yuan

Sun

Wang

et al. 2022

Cancer Prevention Research

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“…In total, 16 (48%) studies present ACERs rather than ICERs [25,30,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]]. An additional 6 (18%) studies estimate ICERs of annual screening without assessment against biennial comparators [28,[32][33][34][35][36].…”

Section: Comparisons and Cost-effectiveness Ratiosmentioning

confidence: 99%

Cost-Effectiveness Analyses of Lung Cancer Screening Using Low-Dose Computed Tomography: A Systematic Review Assessing Strategy Comparison and Risk Stratification

Fabbro

Hahn

Novaes

et al. 2022

PharmacoEconomics Open

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Objectives Our first study objective was to assess the range of lung cancer screening intervals compared within cost-effectiveness analyses (CEAs) of low-dose computed tomography (LDCT) and to examine the implications for the strategies identified as optimally cost effective; the second objective was to examine if and how risk subgroup-specific policies were considered. Methods PubMed, Embase and Web of Science were searched for model-based CEAs of LDCT lung screening. The retrieved studies were assessed to examine if the analyses considered sufficient strategy variation to permit incremental estimation of cost effectiveness. Regarding risk selection, we examined if analyses considered alternative risk strata in separate analyses or as alternative risk-based eligibility criteria for screening. ResultsThe search identified 33 eligible CEAs, 23 of which only considered one screening frequency. Of the 10 analyses considering multiple screening intervals, only 4 included intervals longer than 2 years. Within the 10 studies considering multiple intervals, the optimal policy choice would differ in 5 if biennial intervals or longer had not been considered. Nineteen studies conducted risk subgroup analyses, 12 of which assumed that subgroup-specific policies were possible and 7 of which assumed that a common screening policy applies to all those screened. Conclusions The comparison of multiple strategies is recognised as good practice in CEA when seeking optimal policies. Studies that do include multiple intervals indicate that screening intervals longer than 1 year can be relevant. The omission of intervals of 2 years or longer from CEAs of LDCT screening could lead to the adoption of sub-optimal policies. There also is scope for greater consideration of risk-stratified policies which tailor screening intensity to estimated disease risk. Policy makers should take care when interpreting current evidence before implementing lung screening.

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“…Third, risk-stratified screening intervals should be further refined. Despite many studies comparing different screening intervals, only the population as a whole was analyzed, and the focus was on stratification to either annual, biennial, or triennial screening [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

Liu,

Xu,

et al. 2024

BMC Med

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Background Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals. Methods We conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained. Results Compared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened. Conclusions Risk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit–harm trade-offs and improve the cost-effectiveness of lung cancer screenings.

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Cost-effectiveness analysis of lung cancer screening with low-dose computed tomography in an Iranian high-risk population

Cited by 9 publications

References 25 publications

Cost Effectiveness of Lung Cancer Screening With Low-Dose CT in Heavy Smokers in China

Cost Effectiveness of Lung Cancer Screening With Low-Dose CT in Heavy Smokers in China

Cost-Effectiveness Analyses of Lung Cancer Screening Using Low-Dose Computed Tomography: A Systematic Review Assessing Strategy Comparison and Risk Stratification

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

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