Direct and indirect healthcare costs of lung cancer CT screening in Denmark: a registry study

Abstract

IntroductionA study based on the Danish Randomised Controlled Lung Cancer Screening Trial (DLCST) calculated the healthcare costs of lung cancer screening by comparing costs in an intervention group with a control group. Participants in both groups, however, experienced significantly increased negative psychosocial consequences after randomisation. Substantial participation bias has also been documented: The DLCST participants reported fewer negative psychosocial aspects and experienced better living conditions compared with the random sample.ObjectiveTo comprehensively analyse the costs of lung cancer CT screening and to determine whether invitations to mass screening alter the utilisation of the healthcare system resulting in indirect costs. Healthcare utilisation and costs are analysed in the primary care sector (general practitioner psychologists, physiotherapists, other specialists, drugs) and the secondary care sector (emergency room contacts, outpatient visits, hospitalisation days, surgical procedures and non-surgical procedures).DesignTo account for bias in the original trial, the costs and utilisation of healthcare by participants in DLCST were compared with a new reference group, selected in the period from randomisation (2004–2006) until 2014.SettingFour Danish national registers.ParticipantsDLCST included 4104 current or former heavy smokers, randomly assigned to the CT group or the control group. The new reference group comprised a random sample of 535 current or former heavy smokers in the general Danish population who were never invited to participate in a cancer screening test.Main outcome measuresTotal healthcare costs including costs and utilisation of healthcare in both the primary and the secondary care sector.ResultsCompared with the reference group, the participants in both the CT group (offered annual CT screening, lung function test and smoking counselling) and the control group (offered annual lung function test and smoking counselling) had significantly increased total healthcare costs, calculated at 60% and 48% respectively. The increase in costs was caused by increased use of healthcare in both the primary and the secondary sectors.ConclusionCT screening leads to 60% increased total healthcare costs. Such increase would raise the expected annual healthcare cost per participant from EUR 2348 to EUR 3756. Cost analysis that only includes costs directly related to the CT scan and follow-up procedures most likely underestimates total costs. Our data show that the increased costs are not limited to the secondary sector.Trial registration numberNCT00496977.

Psychosocial consequences of false positives in the Danish Lung Cancer CT Screening Trial: a nested matched cohort study

“…35 This will also increase the costs even more. We have in previous research shown that low-dose CT screening for lung cancer will in a Danish context with a public funded healthcare system increase total health costs by 60% 16 and specifically for those with false-positive results the cost will increase by 66%. 15 The knowledge of psychosocial consequences from false-positive results contributes to the evidence for the benefits and harms of lung cancer CT screening and should be included in the overall assessment of the European trials.…”

“…9 A false-positive screening result can cause both physical and psychosocial harms [10][11][12][13] as well as being costly for the healthcare system. [14][15][16] The average false-positive rate per screening round varies substantially in lung cancer screening trials, for example, 23% in the NLST and 3% in the DLCST (online supplementary appendix 1). 3 17 Qualitative and quantitative studies have shown that false-positive lung cancer screening results can be associated with negative psychosocial consequences both during workup and after the final diagnosis.…”

Psychosocial consequences of a three-month follow-up after receiving an abnormal lung cancer CT-screening result: A longitudinal survey

“…Another study, investigating healthcare use and costs in DLCST participants showed more use of the healthcare system among false-positives and true-positives compared with the control group in the period of time between two screening rounds, which for the false-positives might be valid subtle surrogate outcomes for negative psychosocial consequences [22]. Further, a comprehensive analysis of healthcare costs in DLCST participants showed that the CT group and the control group had significantly increased total healthcare costs, calculated at 60 % and 48 % respectively when they were compared to a random sample of current or former heavy smokers in the general Danish population, who had never been invited to participate in lung cancer screening [23]. This may be associated with the process, described by Andersen and colleagues, where the emphasis on early diagnosis changes the way bodily sensations are interpreted by the public -'what counts as cancer symptoms' is steadily being subdivided, classified and expanded [24].…”

Dépistage du cancer bronchique par tomodensitométrie à faible dose : une revue systématique des essais contrôlés randomisés

“…La qualité de vie a été évaluée par DLCST [59,[80][81][82], UKLS [83] ainsi que dans un sous-groupe de NLST [84] et de NELSON [85][86][87]. DLCST rapporte un impact psychosocial négatif au fil des tours de dépistage chez tous les participants mais significativement plus important dans le bras contrôle.…”