Cost-Effectiveness of Baseline Low-Dose Computed Tomography Screening for Lung Cancer: The Israeli Experience

Shmueli, Amir; Fraifeld, Shifra; Peretz, Tamar; Gutfeld, Orit; Gips, Maya; Sosna, Jacob; Shaham, Dorith

doi:10.1016/j.jval.2013.05.007

Cited by 42 publications

(25 citation statements)

References 19 publications

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“…Although some modellers have presumed that lung cancer develops sufficiently rapidly to produce lead times of around 2 years, [126][127][128] those actually engaged in screening have been more circumspect. Development times of 6 and 8 years between stages 1 (if screen detected) and four (if presenting) have been suggested for Japan 129 and ELCAP, 130 respectively, and these figures set the upper limits on lead times.…”

Section: Lead Timementioning

confidence: 99%

“…The model was re-estimated for annual screening and yielded baseline estimates of £19,060 or £31,800, depending on whether the model's cancer stage predictions derived from the ELCAP-or the NLST-reported stage shift. 141 Finally, a study in Israel 128 reported QALY gains of around 0.06 per person screened, along with an ICER of only £1005 per QALY gained.…”

Section: Comparison With Other Estimatesmentioning

confidence: 99%

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The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

236

231

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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Section: Lead Timementioning

confidence: 99%

Section: Comparison With Other Estimatesmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

236

231

View full text Add to dashboard Cite

show abstract

“…Az irodalomkutatás során 16 olyan költség-hatékonysági modellt találtunk a szakirodalomban, amely az alacsony dózisú CT-vel történő tüdőrákszűrést értékeli (1. táblá-zat) [8,11,[22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Black és mtsai az NLST vizsgálat mentén készült értékelésükben az alacsony dózisú CTvel történő szűrést a szűrés elmaradásának alternatívájá-val, valamint a mellkasröntgennel való szűréssel is össze-vetették.…”

Section: Költség-hatékonysági Modellekunclassified

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Vokó¹,

Barra²,

Molnár³

et al. 2017

Orvosi Hetilap

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Bevezetés: A tüdőrák gyors lefolyású, jellemzően végzetes kimenetelű betegség, amely világszerte jelentős terhet ró a társadalomra. A magyar egészségügy forrásoldalának szűkösségét ismerve egészségpolitikai szempontból alapvető jelentőségű a szűrés bevezetésével kapcsolatban a költség-hatékonyság kérdése. Célkitűzés: A tanulmány célja a magyarországi alacsony dózisú komputertomográfiával végzett tüdőrákszűrés költség-hatékonysági modell koncepciójának kialakítása, illetve az elemzés megvalósításához szükséges lépések számbavétele. Módszer: Célzott irodalomkutatást végeztünk a szűrés hatásosságára és költség-hatékonyságára vonatkozó bizonyíté-kok azonosítására, majd a találatokat a magyarországi viszonyokra való általánosíthatóság alapján értékeltük. Emellett áttekintettük a hazai tudományos bizonyítékokat és rekonstruáltuk a szűrés során előforduló betegutakat. Eredmények: Mindezek alapján Magyarországon az alacsony dózisú komputertomográfiával végzett tüdőrákszűrés teljes körű gazdasági elemzéséhez egy komplex, több almodellből álló modellstruktúrát javaslunk, amely alkalmas a kockázatnak kitett populáció élethosszig tartó követésére. Következtetések: A költség-hatékonysági modell adatokat szolgáltathat további olyan elemzésekhez, amelyek segítik az alacsony dózisú komputertomográfiával végzett tüdőrákszűrés népegészségügyi programként történő bevezetésére vonatkozó szakmai döntések meghozatalát. Orv Hetil. 2017; 158(25): 963-975. Kulcsszavak: alacsony dózisú CT, tüdőrákszűrés, egészség-gazdaságtani modell, költség-hatékonyság Model concept of the health economic evaluation of low-dose CT lung cancer screening in HungaryIntroduction: Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing lowdose computed tomography screening is a relevant health policy matter. Aim: The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. Method: A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. Results: In accordance with these findings, we recommend to perform the full health-economic evaluation of lowdose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon.

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“…The consensus of favorable cost-benefit across recent studies is remarkable, because the studies have varied in many ways, including the national system modeled and the populations modeled (2)(3)(4)(5), the bases of costs and mortality, the projection period, whether inflation or discounting were considered and other methodological issues. Lung cancer screening is truly robust.…”

mentioning

confidence: 99%

Population health’s unanimity on lung cancer screening: far ahead of medical advice

2017

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A recent publication found that lung cancer screening of high risk smokers and ex-smokers is cost-effective in Ontario, Canada. The carefully designed modeling by Ten Haaf et al.(1) agrees with many recent studies-lung cancer screening saves lives at a reasonable cost. Other studies that were based on either the National Lung Screening Trial (NLST) (2) or the International Early Lung Cancer Action Program (I-ELCAP) (3) results have come to this same conclusion. Of note, ten Haaf presents a scenario (scenario 11) where screening reduces deaths from lung cancer by over 80%, which is consistent with I-ELCAP findings. Several other features of ten Haaf's work are notable, including his recognition that "false positives" found by lung cancer screening are very rarely harmful, and that improvements in protocols since NLST will likely further improve cost effectiveness.Lung cancer is the biggest cancer killer, consuming 160,000 US lives each year, so the potential number of lives to be saved are staggering.The consensus of favorable cost-benefit across recent studies is remarkable, because the studies have varied in many ways, including the national system modeled and the populations modeled (2-5), the bases of costs and mortality, the projection period, whether inflation or discounting were considered and other methodological issues. Lung cancer screening is truly robust. Earlier studies that assumed ineffective screening (6) of course concluded that LC screening would be non-cost-effectiveness. The sharp divide between NLST-type assumptions and anti-NLST assumptions was somehow missed by a recent literature review (7).Competent cost-effectiveness analysis in its various guises (cost-benefit, average cost-effectiveness, increment cost effectiveness, etc.) requires real-world modeling of a population's health. Although it is common to model "perfect" compliance, costs must be real and documentable, and impacts are modeled for a population that is followed for long enough-through death for LC screening. In other words, the analysis simulates the lives of at-risk individuals-morality, cost and outcomes year-by-yearwith or without screening. Modeling a population's health dynamics year-by-year avoids errors from misinterpreting short-term results. For lung cancer screening, year-by-year modeling of the shift to diagnosing earlier cancer stages produced relatively uniform results across studies.Modeling and extrapolating results is fundamental to progress and population health. In the mid-1800s, actuaries developing mortality tables invented a Kaplan Meier-like methodology to construct full mortality tables, since the emerging life insurance business did not have the luxury of waiting for a full cohort of births to be observed until everyone died. In healthcare, actuarial and microeconomic models are designed to be credible to decision-makers in business and payers. These models typically inform decision makers among payers, business and government. Such decision makers often have in-depth knowledge of costs,

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Cost-Effectiveness of Baseline Low-Dose Computed Tomography Screening for Lung Cancer: The Israeli Experience

Abstract: Our analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.

Cited by 42 publications

References 19 publications

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Population health’s unanimity on lung cancer screening: far ahead of medical advice

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