Outcomes and cost of lung cancer patients treated surgically or medically in Catalunya: cost–benefit implications for lung cancer screening programs

Abstract

Lung cancer screening programs with computed tomography of the chest reduce mortality by more than 20%. Yet, they have not been implemented widely because of logistic and cost implications. Here, we sought to: (1) use real-life data to compare the outcomes and cost of lung cancer patients with treated medically or surgically in our region and (2) from this data, estimate the cost–benefit ratio of a lung cancer screening program (CRIBAR) soon to be deployed in our region (Catalunya, Spain). We accessed the Catalan Health Surveillance System (CHSS) and analysed data of all patients with a first diagnosis of lung cancer between 1 January 2014 and 31 December 2016. Analysis was carried forward until 30 months (t = 30) after lung cancer diagnosis. Main results showed that: (1) surgically treated lung cancer patients have better survival and return earlier to regular home activities, use less healthcare related resources and cost less tax-payer money and (2) depending on incidence of lung cancer identified and treated in the program (1–2%), the return on investment for CRIBAR is expected to break even at 3–6 years, respectively, after its launch. Surgical treatment of lung cancer is cheaper and offers better outcomes. CRIBAR is estimated to be cost-effective soon after launch.

Changes in Treatment Patterns and Costs for Lung Cancer Have Not Resulted in Relevant Improvements in Survival: A Population-Based Observational Study in Catalonia

“…In relation to survival, treatment patterns that included surgery had clear benefits over curative radiotherapy or treatments aimed at unresectable disease, which was consistent with other observational studies [ 22 , 50 ]. The lack of statistically significant differences in survival for patients undergoing surgery between 2014 and 2018 suggests that there have been no changes in health outcomes or quality of care since cancer surgery in Catalonia was centralized in reference hospitals in 2012 [ 51 , 52 ].…”

“…Different studies have assessed the costs of managing lung cancer in specific European contexts [ 2 , 8 , 22 , 50 , 58 , 59 , 60 , 61 ]. However, it is difficult to compare their results with ours due to differences in the study approach, the unit prices of the procedures and the reimbursed prices of the drugs.…”

To Be or Not To Be: Technical and Cost Implications of Having a Confirmed Diagnosis of Lung Cancer (or not) Before Surgery

“…We have previous reported that surgical treatment of LC is cheaper than medical management and has better outcomes 9 . Here, we extend these previous observations to investigate the impact of having (or not) a pathologically stablished diagnosis of LC before surgery.…”

“…Surgical removal of LC can cure it but, unfortunately, this is possible only in a minority of patients because most of them are diagnosed in advanced stages of the disease that precludes the surgical option [4][5][6][7][8] . Surgical treatment of LC is not only associated with better clinical outcomes, but it is also more cost-effective than other medical therapeutic alternatives 9 . LC screening programs using low dose computed tomography (CT) of the thorax aim to diagnose LC in earlier clinical stages, so surgical removal (and cure) becomes possible.…”

Variation in Model-Based Economic Evaluations of Low-Dose Computed Tomography Screening for Lung Cancer: A Methodological Review

“…One study reports a CBA 41 , where health benefits from the different strategies are defined and compared in monetary terms. The other studies report either CEAs (n=12), CUAs (n=13)…”