Cost-effectiveness of Low-Dose Computed Tomography With a Plasma-Based Biomarker for Lung Cancer Screening in China

Zhao, Zixuan; Wang, Youqing; Wu, Weijia; Yang, Yi; Du, Lingbin; Dong, Hengjin

doi:10.1001/jamanetworkopen.2022.13634

Cited by 10 publications

(12 citation statements)

References 42 publications

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“…The data from the ITALUNG trial was used for a model-based economic evaluation simulating 7 different screening strategies varying selection criteria including the use of MSC in the China 1947 to 1971 birth cohort. This study showed that a combination of LDCT and MSC screening beginning at age 70 to 74 with 20 pack-year smoking history was most cost-effective [68].…”

Section: Micrornamentioning

confidence: 75%

Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities

Broek

Groen

2024

TUB

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Lung cancer (LC) is one of the leading causes for cancer-related deaths in the world, accounting for 28% of all cancer deaths in Europe. Screening for lung cancer can enable earlier detection of LC and reduce lung cancer mortality as was demonstrated in several large image-based screening studies such as the NELSON and the NLST. Based on these studies, screening is recommended in the US and in the UK a targeted lung health check program was initiated. In Europe lung cancer screening (LCS) has not been implemented due to limited data on cost-effectiveness in the different health care systems and questions on for example the selection of high-risk individuals, adherence to screening, management of indeterminate nodules, and risk of overdiagnosis. Liquid biomarkers are considered to have a high potential to address these questions by supporting pre- and post- Low Dose CT (LDCT) risk-assessment thereby improving the overall efficacy of LCS. A wide variety of biomarkers, including cfDNA, miRNA, proteins and inflammatory markers have been studied in the context of LCS. Despite the available data, biomarkers are currently not implemented or evaluated in screening studies or screening programs. As a result, it remains an open question which biomarker will actually improve a LCS program and do this against acceptable costs. In this paper we discuss the current status of different promising biomarkers and the challenges and opportunities of blood-based biomarkers in the context of lung cancer screening.

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Section: Micrornamentioning

confidence: 75%

Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities

Broek

Groen

2024

TUB

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“…In this modelling study, the Markov model on lung cancer screening that developed by our previous work was used and adapted for the purpose of assessing the potential impact of LDCT screening with and without a PRS from a societal perspective. Important assumptions and the overall structure of the model have been thoroughly described before and in supplementary material [ 19 , 20 ]. Per China guideline for the screening and early detection of lung cancer (2021,Beijing) [ 21 ] recommended, 3 hypothetical cohorts of 10,000 current and former smokers aged 50–74 years old were simulated until death or age 79 years (mean life expectancy in China),named non-screening cohort, LDCT screening cohort and LDCT&PRS screening cohort.…”

Section: Methodsmentioning

confidence: 99%

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

Zhao,

Gu,

Yang

et al. 2024

BMC Cancer

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Introduction Several studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear. Methods The comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50–74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted. Results The strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50–74 years. The strategy that screened using LDCT alone from 70–74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone. Conclusion The PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

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“…LDCT can simultaneously detect CVD risk based on coronary artery calci cation (CAC) and earlier-stage COPD through emphysema or air trapping evaluation. 5 Our previous studies, 6,7 as well as many others, [8][9][10][11] have shown that LDCT screening of LC is cost-effective. However, it is still unclear of the effectiveness of screening for all three diseases at the same time.…”

Section: Introductionmentioning

confidence: 96%

Cost-effectiveness of Lung Cancer Screening Combining with CVD and COPD Screening: A Microsimulation Study

Yuan,

Xu,

Sun

et al. 2023

Preprint

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Objective This study aims to estimate the cost-effectiveness of lung cancer (LC), cardiovascular disease (CVD), and chronic obstructive pulmonary disease (COPD), the so-called “big-3 diseases”, combining screening and identify the optimal target screening population in China. Methods A stage shift microsimulation model constructed and different screening strategies were set. Cost, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICER) and net health benefits (NHB) under different screening strategies were calculated. Strategies with a mean ICER less than $38,223 (3 times as much as China’s GDP per capita in 2022) were deemed to be cost-effective, and the optimal one in this case is the strategy with the largest NHB obtained at the same willingness to pay (WTP). One-way and probabilistic sensitivity analysis was conducted to estimate results’ stability. Results ICERs in all strategies ranged from $2,186.5 to 11,227.6 per QALY, which was less than China’s GDP per capita in 2022. This value was basically lower in combined screening for “big-3 diseases” than in screening for LC alone. The largest NHB and probability of cost-effectiveness were both obtained in the strategy with “big-3 diseases” screening for people over 45 years old with a smoking history of 20 pack-year at least. Conclusion The optimal target screening population should be current smokers or smoking quitters in the past 15 years, aged over 45 years old, with a smoking history of 20 pack-year at least. These findings may provide data support for the revision of lung cancer screening guidelines.

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Cost-effectiveness of Low-Dose Computed Tomography With a Plasma-Based Biomarker for Lung Cancer Screening in China

Cited by 10 publications

References 42 publications

Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities

Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

Cost-effectiveness of Lung Cancer Screening Combining with CVD and COPD Screening: A Microsimulation Study

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