Cost-Effectiveness of CT Screening in the National Lung Screening Trial

Abstract

BACKGROUND The National Lung Screening Trial (NLST) showed that screening with low-dose computed tomography (CT) as compared with chest radiography reduced lung-cancer mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST. METHODS We estimated mean life-years, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratios (ICERs) for three alternative strategies: screening with low-dose CT, screening with radiography, and no screening. Estimations of life-years were based on the number of observed deaths that occurred during the trial and the projected survival of persons who were alive at the end of the trial. Quality adjustments were derived from a subgroup of participants who were selected to complete quality-of-life surveys. Costs were based on utilization rates and Medicare reimbursements. We also performed analyses of subgroups defined according to age, sex, smoking history, and risk of lung cancer and performed sensitivity analyses based on several assumptions. RESULTS As compared with no screening, screening with low-dose CT cost an additional $1,631 per person (95% confidence interval [CI], 1,557 to 1,709) and provided an additional 0.0316 life-years per person (95% CI, 0.0154 to 0.0478) and 0.0201 QALYs per person (95% CI, 0.0088 to 0.0314). The corresponding ICERs were $52,000 per life-year gained (95% CI, 34,000 to 106,000) and $81,000 per QALY gained (95% CI, 52,000 to 186,000). However, the ICERs varied widely in subgroup and sensitivity analyses. CONCLUSIONS We estimated that screening for lung cancer with low-dose CT would cost $81,000 per QALY gained, but we also determined that modest changes in our assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.)

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

“…38 The work of the International Early Lung Cancer Action Program (IELCAP) 39 combined with the only large scale randomized trial of sufficient size to demonstrate a mortality benefit from CT, the National Lung Screening Trial (NLST), 40 and demonstration of cost effectiveness comparable to other screening tests 41 led to the recognition of low dose CT scanning as an appropriate screening test by the US Preventative Services Task Force in 2014. The Grade B recommendation, that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial, was designated for annual low dose chest CT in individuals at high risk for lung cancer based on age and smoking history, defined as a 30 pack-year or more history of smoking in subjects age 55e79 years who are either current smokers, or former smokers who quit within the past 15 years.…”

Selecting High-Risk Individuals for Lung Cancer Screening: A Prospective Evaluation of Existing Risk Models and Eligibility Criteria in the German EPIC Cohort

“…A recently published work from Black and colleagues shows that confining screening with LDCT to higher risk subjects (fourth and fifth quintiles of the PLCO M2012 risk score) led to significantly lower cost per quality-adjusted life year gained when compared with screening among the lower-risk subjects (35).…”

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

“…Az irodalomkutatás során 16 olyan költség-hatékonysági modellt találtunk a szakirodalomban, amely az alacsony dózisú CT-vel történő tüdőrákszűrést értékeli (1. táblá-zat) [8,11,[22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Black és mtsai az NLST vizsgálat mentén készült értékelésükben az alacsony dózisú CTvel történő szűrést a szűrés elmaradásának alternatívájá-val, valamint a mellkasröntgennel való szűréssel is össze-vetették.…”

“…Az Amerikai Egyesült Államokban 2011-ben közölték egy több mint 53 000 főt bevonó, randomizált, kontrollcsoportos vizsgálat, a National Lung Screening Trial (NLST) eredményeit, amelyben az alacsony dózisú CT-vel történő tüdőrákszűrést hasonlították a mellkasröntgennel végzett tüdőszűréshez. Az alacsony dózisú CT-vel történő szűrés 20%-os tüdőrák-mortalitást csök-kentő hatását mutatták ki [4], majd a vizsgálat mentén végzett gazdasági értékelésben a CT-szűrés költség-hatékonyságát is igazolták az Egyesült Államokra vonatkozóan [11]. Az alacsony dózisú CT-vel történő tüdőrák-szűrést Európában is élénk érdeklődés övezi, jelenleg több randomizált, kontrollált vizsgálat zajlik a CT-szűrés hatásosságának megítélésére.…”