The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

Cressman, Sonya; Peacock, Stuart; Tammemägi, Martin C.; Evans, William K.; Leighl, Natasha B.; Goffin, John R.; Tremblay, Alain; Liu, Geoffrey; Manos, Daria; MacEachern, Paul; Bhatia, Rick; Puksa, Serge; Nicholas, Garth; McWilliams, Annette; Mayo, John R.; Yee, John; English, John; Pataky, Reka; McPherson, Emily; Atkar-Khattra, Sukhinder; Johnston, Michael; Schmidt, Heidi; Shepherd, Frances A.; Soghrati, Kam; Amjadi, Kayvan; Burrowes, Paul; Couture, Christian; Sekhon, Harmanjatinder S.; Yasufuku, Kazuhiro; Goss, Glenwood D.; Ionescu, Diana N.; Hwang, David; Martel, Simon; Sin, Don D.; Tan, Wan C.; Urbanski, Stefan J.; Xu, Zhaolin; Tsao, Ming‐Sound; Lam, Stephen

doi:10.1016/j.jtho.2017.04.021

Cited by 112 publications

(99 citation statements)

References 38 publications

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“…For instance, the ICER value of a study based on SEER National Cancer Database in the United States was presented as 116,300 USD/QALY [15] The Markov model was also applied in that study to simulate the annual LDCT screening on lung cancer received by those severe smokers at age of 60. The ICER value (116,300 USD/QALY) of screening strategies in that study far greater than ours (13,736 USD/QALY). The gap originates from the discrepancy in the costs of screening and biopsy diagnosis(300 USD for LDCT screening in that study and 68 USD in this one, the cost for biopsy diagnosis also outweigh ours a lot).…”

Section: Discussioncontrasting

confidence: 55%

“…However, these conclusions were not consistent due to the differences in the cost of diagnosis and treatment and the incidence of lung cancer in various countries. Some studies showed that screening is cost-effective [11][12][13] and the others are different [14,15] . At present, there are few studies on the costeffectiveness of lung cancer screening in China [16] .…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

Sun¹,

Zhang²,

Guo³

et al. 2020

Preprint

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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.

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

Sun¹,

Zhang²,

Guo³

et al. 2020

Preprint

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“…32,33,41 However, data demonstrating that the balance of harm, benefits, and costs can be optimized with the use of lung cancer risk prediction tools are mounting. 42,43 These tools are now being incorporated into trial eligibility criteria [44][45][46] and are expected to improve screening effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

Wade

Weber

Kang

et al. 2018

Journal of Thoracic Oncology

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“…Policy decisions to implement LCS programmes are limited by the availability of population-level evidence to predict health system and public health impacts. Simulation models have been used to overcome this limitation [145]. An analysis of the NLST data estimated that the cost of LCS would be USD 81 000 per QALY gained [23], which is well below the threshold considered reasonable in the USA of USD 100 000 per QALY gained.…”

Section: Cost-effectiveness Of Lcsmentioning

confidence: 99%

ESR/ERS statement paper on lung cancer screening

et al. 2020

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In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.

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The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

Abstract: Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise.

Cited by 112 publications

References 38 publications

Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

ESR/ERS statement paper on lung cancer screening

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