P3.11-25 Analysis Indicates Low Incremental Cost-Effectiveness Ratio for Implementation of Lung Cancer Screening in Italy

Abstract

Background: Despite introduction in America and calls for European implementation, lung screening isn't currently endorsed as a UK programme. Whether smokers want to be screened has been raised as an issue. This study explored uptake decision-making with ever-smokers, aged 50-80 as part of the UK's first community based one-stop lung screening pilot service. Method: Thirty-three participants (22 exsmokers; 11 smokers) men and women, aged 50-80 were recruited purposively from community settings and health facilities in Manchester, England. The setting is a city with significant deprivation and high lung cancer incidence. Six semi-structured focus groups were held with separate groups for current and former smokers to facilitate freer expression and comparison but mixed by gender, age, ethnicity and deprivation. Discussions followed semi-structured topic guides were audio-recorded, transcribed verbatim and coded using NVIVO software. Inductive thematic analysis was used to analyse data and identify key themes. Result: Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. However, being positive 'in principle' didn't always translate into uptake intention. Factors that impacted participants' desire to know about their lung health included: views about screening benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as service accessibility; and smoking related factors included views about individual smoking risk and smoking stigma. Conclusion: Indications were that current smokers faced higher uptake barriers than ex-smokers. The uptake factors identified appeared to motivate some participants to be screened but act as a barrier for others. This factorial 'push and pull' effect is important as it indicates where action can be taken to help reduce participation barriers to lung screening. This is shown in Figure One.Background: Given the potential of early lung cancer detection to improve survival, accurate assessment of the cost-effectiveness of lowdose computed tomography (LDCT) screening is crucial. We report the results of a cost-effectiveness analysis of screening for Italian persons at high risk of lung cancer from the public payer's perspective Method:The study built on a mathematical decision model to estimate the costeffectiveness of annual LDCT screening for 5 years in a high-risk population of smokers (at least 30 pack-years) aged 55-79 years. The stage distribution of patients diagnosed as part of the COSMOS screening study was used for the "screening arm;" the stage distribution of patients in the SEER database was used for the "usual care arm." Treatment costs were determined using detailed individual-level administrative information from our Institutional database of lung cancer patients. Lung cancer survival in screened patients was adjusted for 2 year-lead time bias. The model estimated expected future life years using survival probabilities according to age, s...

ESR/ERS statement paper on lung cancer screening

“…Further CEAs performed in Canada and in a number of European countries [146,147] indicate that LCS can be cost-effective in different healthcare systems, depending on factors such as inclusion criteria, algorithms for positive screen results, screening intervals and tobacco cessation interventions [10,23,145,148,149]. A CEA from the public payer's perspective indicates that LDCT screening in high-risk participants is associated with an ICER well below the one accepted by health institutions such as the UK National Institute for Health and Care Excellence [150]. LCS has been reported to be more effective in women than men and more effective in people with a higher risk of lung cancer than those with a lower risk [23].…”