Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects

Abstract

Background: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for an asbestos-exposed population. Methods: Using Markov modelization, individuals with asbestos exposure were either monitored without intervention or annual low-dose thoracic computed-tomography (LDTCT) scan LC screening. LC incidence came from a prospective observational cohort of subjects with occupational asbestos exposure. The intervention parameters were those of the NLST study. Utilities and LC-management costs came from published reports. A sensitivity analysis evaluated different screening strategies. Results: The respective quality-adjusted life year (QALY) gain, supplementary costs and ICER [95% confidence interval] were: 0.040 [0.010–0.065] QALY, 6900 [3700–11,800] € and 170,000 [75,000–645,000] €/QALY for all asbestos-exposed subjects; and 0.144 [0.071–0.216] QALY, 13,000 [5700–26,800] € and 90,000 [35,000–276,000] €/QALY for smokers with high exposure. When screening was based on biennial LDTCT scans, the ICER was 45,000 [95% CI: 15,000–116,000] €/QALY. Conclusions: Compared to the usual ICER thresholds, biennial LDTCT scan LC screening for smokers with high occupational exposure to asbestos is acceptable and preferable to annual scans.

Lung cancer: Removing toxic dust from our environment

“…Given the prevalence of asbestos exposure globally in the industrialized age and its known carcinogenic properties, it is not surprising that the screening and surveillance of asbestos-exposed populations are relatively well studied. [1][2][3][4][5][6][7][8][9] The value of screening of asbestos-exposed people by lowdose computer tomography (LDCT) of the chest has not been confirmed in randomized clinical trials, but observational studies strongly suggest that LDCT is an effective tool for early lung cancer detection. 10 Most observational studies reviewed concluded that the criteria used to select individuals for LDCT may need broadening.…”