Cost-Effectiveness Analysis of Lung Cancer Screening in the United States

Criss, Steven D.; Cao, Pianpian; Bastani, Mehrad; Haaf, Kevin ten; Chen, Yufan; Sheehan, Deirdre F.; Blom, Erik F.; Toumazis, Iakovos; Jeon, Jihyoun; Koning, Harry J. de; Plevritis, Sylvia K.; Meza, Rafael; Kong, Chung Yin

doi:10.7326/m19-0322

Cited by 89 publications

(79 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…47,50,113 Given that CT examinations account for a substantial proportion of the costs associated with lung cancer screening programs, reducing the number of required CT examinations while retaining program efficacy would improve its cost-effectiveness. [114][115][116] Furthermore, due to the increased demand for medical imaging over the past decades, radiologist capacity for interpreting lung cancer screening examinations is restricted in many countries; therefore, reducing the number of CT examinations would facilitate implementation. [117][118][119] Consequently, research has been ongoing on using CT screening information to determine suitable screening intervals.…”

Section: Determination Of the Screening Intervalmentioning

confidence: 99%

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

View full text Add to dashboard Cite

Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population-based screening programs. Due to smoking behaviour being the primary risk-factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk-based. In fact, the selection of high-risk individuals has been shown to be essential in implementing lung cancer screening in a cost-effective manner. Furthermore, studies have shown that further riskstratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk-based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk-based approaches can negatively influence the trade-off between individual benefits and harms if not applied thoughtfully. Large-scale implementation of targeted, risk-based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high-risk individuals from the general population. Finally, while risk-based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk-stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact. K E Y W O R D S lung cancer screening, personalised screening, risk-based screening Abbreviations: 4-IN-THE-LUNG-RUN, (Towards INdividually tailored INvitations screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) implementation trial; AUC, area under the receiver operating characteristic curve; BMI, body mass index; bioMILD, the Plasma microRNA Profiling as First Line Screening Test for Lung Cancer Detection: a

show abstract

Section: Determination Of the Screening Intervalmentioning

confidence: 99%

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…3 4 International evidence from a number of large randomised controlled trials (RCTs) shows that low-dose CT (LDCT) screening for lung cancer reduces lung cancer mortality [5][6][7][8][9] and can also be cost-effective if stringent riskbased eligibility criteria are employed. [10][11][12][13][14] As the evidence base for LDCT lung cancer screening evolves with improvements to the screening protocols, the likely impacts and cost-effectiveness of such a programme in the NZ context have changed. The most recent evidence of efficacy comes from the Nederlands-Leuvens Longkanker Screenings…”

Section: Introductionmentioning

confidence: 99%

Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

McLeod

Sandiford

Kvizhinadze³

et al. 2020

BMJ Open

View full text Add to dashboard Cite

ObjectiveThere are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years.DesignA Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets.SettingNew Zealand.ParticipantsPopulation aged 55–74 years in 2011.InterventionsBiennial LDCT screening for lung cancer compared with usual care.Outcome measuresIncremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and ‘health-adjusted life expectancy’ (HALE) were measured.ResultsLDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival.ConclusionA national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.

show abstract

“…Black et al [23] assigned a cost of $500 for a patient with a clinically significant incidental finding [23], whereas Cressman et al [22] assigned a cost of $1,021 (Canadian) and determined that including the cost of incidental findings raised the incremental costeffectiveness ratio only moderately (from $20,724 to $31,656 per quality-adjusted life-year gained). Differences among the analyses were driven largely by variations in study populations and time span used for modeling, but despite these considerable differences, virtually all recent studies conclude that lung cancer screening with LDCT is cost effective in carefully selected populations [19][20][21][22]. An actuarial analysis also concluded that lung cancer screening with LDCT compares favorably with screening for breast, cervical, and colon cancer [24].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the cost-effectiveness of lung cancer screening, and most studies have concluded that lung cancer screening is cost effective in stringently selected patient populations [19][20][21][22][23]. An actuarial analysis also showed that lung cancer screening compares favorably with breast, cervical, and colon cancer screening with regard to costeffectiveness [24].…”

Section: Introductionmentioning

confidence: 99%

Detection of Extrapulmonary Malignancy During Lung Cancer Screening: 5-Year Analysis at a Tertiary Hospital

Chintanapakdee

Mendoza

Zhang

et al. 2020

Journal of the American College of Radiology

View full text Add to dashboard Cite

Cost-Effectiveness Analysis of Lung Cancer Screening in the United States

Cited by 89 publications

References 43 publications

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

Detection of Extrapulmonary Malignancy During Lung Cancer Screening: 5-Year Analysis at a Tertiary Hospital

Contact Info

Product

Resources

About