Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

Abstract

Background: Lung cancer is the leading cause of cancer-related death. Currently, lung cancer screening trials have demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer specific and overall mortality. The effectiveness of LDCT has been proven, but its economical efficiency should also be assessed. The purpose of the study is to analyze the cost-effectiveness of annual LDCT screening of high-risk populations in Chinese urban areas.Method: We use Markov model to evaluate LDCT screening from sociological perspective. The sample size is 100,000 smokers who will undergo annual LDCT screening until 76. The study contains 5 screening strategies, the initial screening ages for the five screening strategies and their corresponding unscreened strategies are 40, 45, 50, 55, and 60 years, respectively. Parameters come from the China Lung Cancer Screening Project, cancer registry data, etc. The Incremental Cost-effectiveness Ratio (ICER) between screening and non-screening strategies at the same initial age is evaluated.Result: In base-case scenario, compared with those who are not screened, specific mortality of lung cancer decreased by 18.52%-23.13% of 5 screening strategies. The ICER of LDCT screening is from 13056.82USD to 15736.06USD per quality-adjusted life year (QALY), which is greater than one time and less than three times GDP per capita in China. Initial screening age of 55 is the most cost-effective strategy.Conclusion: Baseline analysis shows that annual LDCT screening in heavy smokers in Chinese urban areas is likely to be cost-effectiveness. Sensitivity analysis shows that sensitivity, specificity and over-diagnosis rate have an impact on cost-effectiveness of LDCT screening, but the results are relatively robust，unless the sensitivity, specificity of LDCT screening and over-diagnosis rate take the worst value at the same time. Therefore, the cost-effectiveness of screening strategy depends on the performance of LDCT screening.