Cost Utility Analysis of a Pilot Study for the Korean Lung Cancer Screening Project

Abstract

The aim of this study was to evaluate the cost utility of a pilot study of Korean lung cancer screening project. Materials and MethodsWe constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55-74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate. ResultsThe base case (US$25,383 per QALY gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution. ConclusionOur results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.

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

“…All the cost-effectiveness ratios estimated by studies in Category 3 except Kim et al, are ICERs as they are incremental comparisons between both alternative screening intervals and alternative candidate age ranges. While Kim et al does consider alternative intervals and age ranges, the reported ICERs are actually ACER comparisons to no screening [ 39 ].…”

“…Nine of the ten studies that considered multiple screening intervals assessed annual and biennial screening [ 13 , 27 , 29 , 37 , 39 , 53 – 56 ]. In these cases, biennial screening offers a lower intensity strategy against which to assess the incremental cost effectiveness of annual screening.…”

“…Our review finds only nine analyses that have assessed both annual and biennial screening [ 13 , 27 , 29 , 37 , 39 , 53 , 54 , 56 , 57 ], meaning less than one-third of the reviewed literature offers an incremental basis for assessing annual screening. Of these, only three considered intervals longer than 2 years [ 13 , 53 , 56 ], meaning even fewer offer incremental evidence for biennial screening.…”

“…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].…”

“…1 Corresponding to the assumption of a 4% utility decrement for indeterminate findings are classified as reporting ICERs as they have assessed onetime screening per lifetime [30,31]. Nine of the ten studies that considered multiple screening intervals assessed annual and biennial screening [13,27,29,37,39,[53][54][55][56]. In these cases, biennial screening offers a lower intensity strategy against which to assess the incremental cost effectiveness of annual screening.…”