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Cost-effectiveness of computed tomography screening for lung cancer in the United States.

ABSTRACT: A randomized trial has demonstrated that lung cancer screening reduces mortality. Identifying participant and program characteristics that influence the cost-effectiveness of screening will help translate trial results into benefits at the population level.Six U.S. cohorts (men and women aged 50, 60, or 70 years) were simulated in an existing patient-level lung cancer model. Smoking histories reflected observed U.S. patterns. We simulated lifetime histories of 500,000 identical individuals per cohort in each scenario. Costs per quality-adjusted life-year gained ($/QALY) were estimated for each program: computed tomography screening; stand-alone smoking cessation therapies (4-30% 1-year abstinence); and combined programs.Annual screening of current and former smokers aged 50 to 74 years costs between $126,000 and $169,000/QALY (minimum 20 pack-years of smoking) or $110,000 and $166,000/QALY (40 pack-year minimum), when compared with no screening and assuming background quit rates. Screening was beneficial but had a higher cost per QALY when the model included radiation-induced lung cancers. If screen participation doubled background quit rates, the cost of annual screening (at age 50 years, 20 pack-year minimum) was below $75,000/QALY. If screen participation halved background quit rates, benefits from screening were nearly erased. If screening had no effect on quit rates, annual screening costs more but provided fewer QALYs than annual cessation therapies. Annual combined screening/cessation therapy programs at age 50 years costs $130,500 to $159,700/QALY, when compared with annual stand-alone cessation.The cost-effectiveness of computed tomography screening will likely be strongly linked to achievable smoking cessation rates. Trials and further modeling should explore the consequences of relationships between smoking behaviors and screen participation.

SUBMITTER: McMahon PM

PROVIDER: S-EPMC3202298 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Cost-effectiveness of computed tomography screening for lung cancer in the United States.

McMahon Pamela M PM Kong Chung Yin CY Bouzan Colleen C Weinstein Milton C MC Cipriano Lauren E LE Tramontano Angela C AC Johnson Bruce E BE Weeks Jane C JC Gazelle G Scott GS

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 20111101 11

<h4>Introduction</h4>A randomized trial has demonstrated that lung cancer screening reduces mortality. Identifying participant and program characteristics that influence the cost-effectiveness of screening will help translate trial results into benefits at the population level.<h4>Methods</h4>Six U.S. cohorts (men and women aged 50, 60, or 70 years) were simulated in an existing patient-level lung cancer model. Smoking histories reflected observed U.S. patterns. We simulated lifetime histories o ...[more]

PMID: 21892105

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Project description:ImportanceChina, which has one-third of the worldwide smoking population, has a substantial cancer burden, with lung cancer being the leading cause of cancer-related death. The effectiveness of lung cancer screening for mortality reduction has been confirmed, but the cost-effectiveness of diverse screening modalities remains unclear.ObjectiveTo compare the cost-effectiveness of low-dose computed tomography (LDCT) with a biomarker (micro-RNA signature classifier [MSC]) with that of LDCT alone by screening interval and cumulative smoking exposure.Design, setting, and participantsIn this economic evaluation, a comparative cost-effectiveness analysis used Markov state transition models that simulated the 1947 to 1971 China birth cohort. Simulated individuals in 8 cohorts of 10 000 entered the study between ages 50 and 74 years and were followed up until death or age 79 years, corresponding to a study period from January 1, 2021, to December 31, 2050. The model was run with a cycle length of 1 year. All the transition probabilities were validated, and health utility values were extracted from published literature. Cost parameters were derived from the databases of local medical insurance bureaus.Main outcomes and measuresPrimary outcomes included life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) with future costs and outcomes discounted by 5%. Screening strategies with a mean ICER less than Chinese yuan (CNY) 212 676 per QALY gained were deemed to be cost-effective. The cost-effectiveness of 7 alternative screening strategies with a screening starting age of 50 years, minimum cumulative smoking exposure of 20 vs 30 pack-years, and screening interval of annual vs 1 time was estimated, including the 2021 China guideline-recommended strategy (LDCT, annual, 30 pack-years) and the 2018 China guideline-recommended strategy (LDCT, annual, 20 pack-years).ResultsIn a simulated population of 80 000 individuals, the conjunctive LDCT and MSC screening strategy was estimated to obtain an ICER of CNY -793 995.17 to 254 417.46 (minimum cumulative smoking exposure, 20-30 pack-years) per QALY gained compared with LDCT screening alone. China's 2021 guideline-recommended strategy was not cost-effective compared with the 2018 guideline-recommended strategy, with higher costs and fewer QALYs gained; the QALY loss ranged from 0.02 to 0.15 per person and the increase in cost ranged from CNY 945.89 to CNY 5131.29 per person. LDCT and MSC screening beginning at age 70 to 74 years in individuals with a 20 pack-year smoking history was the most cost-effective strategy, with an ICER of CNY -793 995.17 per QALY gained. Lowering the minimum cumulative smoking exposure for screening from 30 to 20 pack-years and maintaining annual screening were associated with greater cost savings regardless of the screening tool.Conclusions and relevanceThis economic evaluation found that China's 2018 recommendation for lung cancer screening was more cost-effective than the 2021 recommendation. Moreover, the cost-effectiveness of lung cancer screening was improved when MSC was included with LDCT. These findings may be useful for the modification of guidelines for lung cancer screening.

Project description:IntroductionSeveral studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear.MethodsThe comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50-74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted.ResultsThe strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50-74 years. The strategy that screened using LDCT alone from 70-74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone.ConclusionThe PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

Project description:ObjectiveTo determine the effect of the introduction of low dose computed tomography screening in 2013 on lung cancer stage shift, survival, and disparities in the stage of lung cancer diagnosed in the United States.DesignQuasi-experimental study using Joinpoint modeling, multivariable ordinal logistic regression, and multivariable Cox proportional hazards modeling.SettingUS National Cancer Database and Surveillance Epidemiology End Results program database.ParticipantsPatients aged 45-80 years diagnosed as having non-small cell lung cancer (NSCLC) between 1 January 2010 and 31 December 2018.Main outcome measuresAnnual per cent change in percentage of stage I NSCLC diagnosed among patients aged 45-54 (ineligible for screening) and 55-80 (potentially eligible for screening), median all cause survival, and incidence of NSCLC; multivariable adjusted odds ratios for year-to-year changes in likelihood of having earlier stages of disease at diagnosis and multivariable adjusted hazard ratios for changes in hazard of death before versus after introduction of screening.ResultsThe percentage of stage I NSCLC diagnosed among patients aged 55-80 did not significantly increase from 2010 to 2013 (from 27.8% to 29.4%) and then increased at 3.9% (95% confidence interval 3.0% to 4.8%) per year from 2014 to 2018 (from 30.2% to 35.5%). In multivariable adjusted analysis, the increase in the odds per year of a patient having one lung cancer stage lower at diagnosis during the time period from 2014 to 2018 was 6.2% (multivariable adjusted odds ratio 1.062, 95% confidence interval 1.048 to 1.077; P<0.001) higher than the increase in the odds per year from 2010 to 2013. Similarly, the median all cause survival of patients aged 55-80 did not significantly increase from 2010 to 2013 (from 15.8 to 18.1 months), and then increased at 11.9% (8.9% to 15.0%) per year from 2014 to 2018 (from 19.7 to 28.2 months). In multivariable adjusted analysis, the hazard of death decreased significantly faster after 2014 compared with before 2014 (P<0.001). By 2018, stage I NSCLC was the predominant diagnosis among non-Hispanic white people and people living in the highest income or best educated regions. Non-white people and those living in lower income or less educated regions remained more likely to have stage IV disease at diagnosis. Increases in the detection of early stage disease in the US from 2014 to 2018 led to an estimated 10 100 averted deaths.ConclusionsA recent stage shift toward stage I NSCLC coincides with improved survival and the introduction of lung cancer screening. Non-white patients and those living in areas of greater deprivation had lower rates of stage I disease identified, highlighting the need for efforts to increase access to screening in the US.

Project description:BackgroundLung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer-specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear.ObjectiveThis study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval.MethodsA Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer-specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening.ResultsThe proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer-related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted.ConclusionsThis economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program.

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Cost-effectiveness of computed tomography screening for lung cancer in the United States.

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Cost-effectiveness of computed tomography screening for lung cancer in the United States.

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