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

Peters, Jaime; Snowsill, Tristan; Griffin, Edward; Robinson, Sophie; Hyde, Chris

doi:10.1016/j.jval.2021.11.1352

Cited by 7 publications

(8 citation statements)

References 40 publications

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“…This review is focused on issues of strategy comparison and stratification. Peters et al provide a comprehensive analysis of other issues regarding methodology that we did not address [ 15 ]. We did not consider the adequacy of parameterisation given RCT and epidemiological data or the models’ structural assumptions.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Several existing reviews have examined the cost-effectiveness evidence for CT lung screening [7][8][9][10][11][12][13][14][15][16]. Peters et al provide a recent, detailed and comprehensive analysis of methodological variation between published analyses [15]. That review and Raymakers et al note the wide range in incremental cost-effectiveness ratio (ICER) estimates, varying from $US1464/quality-adjusted life-year (QALY) to $US207,000/QALY [8,15].…”

Section: Introductionmentioning

confidence: 99%

“…Peters et al provide a recent, detailed and comprehensive analysis of methodological variation between published analyses [ 15 ]. That review and Raymakers et al note the wide range in incremental cost-effectiveness ratio (ICER) estimates, varying from $US1464/quality-adjusted life-year (QALY) to $US207,000/QALY [ 8 , 15 ]. Ngo et al provide a detailed review of utility weights in CEAs of lung screening [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ngo et al provide a detailed review of utility weights in CEAs of lung screening [ 16 ]. Several reviews have commented critically on the methodological shortcomings within the literature, especially in older pre-NLST/NELSON studies [ 9 , 11 , 13 , 15 ]. Both Peters et al and Raymakers et al report most analyses compare annual screening relative to no screening [ 8 , 15 ], the significance of which this review examines in detail.…”

Section: Introductionmentioning

confidence: 99%

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

Fabbro

Hahn

Novaes

et al. 2022

PharmacoEconomics Open

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Objectives Our first study objective was to assess the range of lung cancer screening intervals compared within cost-effectiveness analyses (CEAs) of low-dose computed tomography (LDCT) and to examine the implications for the strategies identified as optimally cost effective; the second objective was to examine if and how risk subgroup-specific policies were considered. Methods PubMed, Embase and Web of Science were searched for model-based CEAs of LDCT lung screening. The retrieved studies were assessed to examine if the analyses considered sufficient strategy variation to permit incremental estimation of cost effectiveness. Regarding risk selection, we examined if analyses considered alternative risk strata in separate analyses or as alternative risk-based eligibility criteria for screening. ResultsThe search identified 33 eligible CEAs, 23 of which only considered one screening frequency. Of the 10 analyses considering multiple screening intervals, only 4 included intervals longer than 2 years. Within the 10 studies considering multiple intervals, the optimal policy choice would differ in 5 if biennial intervals or longer had not been considered. Nineteen studies conducted risk subgroup analyses, 12 of which assumed that subgroup-specific policies were possible and 7 of which assumed that a common screening policy applies to all those screened. Conclusions The comparison of multiple strategies is recognised as good practice in CEA when seeking optimal policies. Studies that do include multiple intervals indicate that screening intervals longer than 1 year can be relevant. The omission of intervals of 2 years or longer from CEAs of LDCT screening could lead to the adoption of sub-optimal policies. There also is scope for greater consideration of risk-stratified policies which tailor screening intensity to estimated disease risk. Policy makers should take care when interpreting current evidence before implementing lung screening.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Fabbro

Hahn

Novaes

et al. 2022

PharmacoEconomics Open

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Population-Based Screening Using Low-Dose Chest Computed Tomography: A Systematic Review of Health Economic Evaluations

et al. 2023

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Background Chest low-dose computed tomography (LDCT) is a promising technology for population-based screening because it is non-invasive, relatively inexpensive, associated with low radiation and highly sensitive to lung cancer. To improve the cost-effectiveness of lung cancer screening, simultaneous screening for other diseases could be considered. This systematic review was conducted to analyse studies that published evidence on the cost-effectiveness of chest LDCT screening programs for different diseases. Methods Scopus and PubMed were searched for English publications (1 January 2011-22 July 2022) using search terms related to screening, computed tomography and cost-effectiveness. An additional search specifically searched for the costeffectiveness of screening for lung cancer, chronic obstructive pulmonary disease or cardiovascular disease. Included publications should present a full health economic evaluation of population screening with chest LDCT. The extracted data included the disease screened for, model type, country context of screening, inclusion of comorbidities or incidental findings, incremental costs, incremental effects and the resulting cost-effectiveness ratio amongst others. Reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. ResultsThe search yielded 1799 unique papers, of which 43 were included. Most papers focused on lung cancer screening (n = 40), and three were on coronary calcium scoring. Microsimulation was the most commonly applied modelling type (n = 16), followed by life table analysis (n = 10) and Markov cohort models (n = 10). Studies reflected the healthcare context of the US (n = 15), Canada (n = 4), the UK (n = 3) and 13 other countries. The reported incremental cost-effectiveness ratio ranged from US$10,000 to US$90,000/quality-adjusted life year (QALY) for lung cancer screening compared to no screening and was US$15,900/QALY-US$45,300/QALY for coronary calcium scoring compared to no screening. Discussion Almost all health economic evaluations of LDCT screening focused on lung cancer. Literature regarding the health economic benefits of simultaneous LDCT screening for multiple diseases is absent. Most studies suggest LDCT screening is cost-effective for current and former smokers aged 55-74 with a minimum of 30 pack-years of smoking history. Consequently, more evidence on LDCT is needed to support further cost-effectiveness analyses. Preferably evidence on simultaneous screening for multiple diseases is needed, but alternatively, on single-disease screening. Registration of systematic review Prospective Register of Ongoing Systematic Reviews registration CRD42021290228 can be accessed https:// www. crd. york. ac. uk/ prosp ero/ displ ay_ record. php? Recor dID= 290228.

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Lung cancer screening

et al. 2023

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

Cited by 7 publications

References 40 publications

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

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

Population-Based Screening Using Low-Dose Chest Computed Tomography: A Systematic Review of Health Economic Evaluations

Lung cancer screening

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