Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan

Yang, Sheng‐An; Lai, Wu‐Wei; Lin, Chien‐Chung; Su, Wu Chou; Ku, Liu; Hwang, J. S.; Wang, Jung‐Der

doi:10.1016/j.lungcan.2017.04.001

Cited by 52 publications

(64 citation statements)

References 32 publications

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“…Most of those interventions were minimally invasive ENBguided and EBUS-guided bronchoscopy procedures. Although we did not conduct a formal costeffectiveness analysis, our results support prior publications from Europe [32], the United Kingdom [33], Asia [34], and the United States [35,36] demonstrating the cost-effectiveness of screening and incidental nodule programs.…”

Section: Discussionsupporting

confidence: 76%

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

LeMense

Waller²,

Campbell³

et al. 2020

Preprint

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Background: Appropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes. However, the implementation and management of comprehensive lung nodule programs is challenging. Methods: This single-center, retrospective report describes the development and outcomes of a comprehensive lung nodule program at a community practice in Tennessee. Computed tomography (CT) scans potentially revealing incidental lung nodules were identified by a computerized search. Incidental or screening-identified lung nodules that were enlarging or not seen in prior scans were entered into a nodule database and guideline-based review determined whether to conduct a diagnostic intervention or radiologic follow-up. Referral rates, diagnosis methods, stage distribution, treatment modalities, and days to treatment are reported. Results: The number of patients with lung nodules referred to the program increased over 2 years, from 665 patients in Year 1 to 745 patients in Year 2. Most nodules were incidental (62%-65%). Nodules identified with symptoms (15.2% in Year 1) or through screening (12.6% in Year 1) were less common. In Year 1, 27% (182/665) of nodules required a diagnostic intervention and 18% (121/665) were malignant. Most diagnostic interventions were image-guided bronchoscopy (88%) or percutaneous biopsy (9%). The proportion of Stage I-II cancer diagnoses increased from 23% prior to program implementation to 36% in Year 1 and 38% in Year 2. In screening cases, 71% of patients completed follow-up scans within 18 months. Only 2% of Year 1 patients under watchful waiting required a diagnostic intervention, of which 1% received a cancer diagnosis. Conclusions: The current study reports outcomes over the first two years of a lung cancer screening and incidental nodule program. The results show that the program was successful, given the appropriate level of data management and oversight. Comprehensive lung nodule programs have the potential to benefit the patient, physician, and hospital system.

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Section: Discussionsupporting

confidence: 76%

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

LeMense

Waller²,

Campbell³

et al. 2020

Preprint

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“…In Taiwan, the majority of lung cancer cases identified by the use of lowdose CTscreening were adenocarcinoma at early stage. us, implementation of CT screening in Taiwan would be more cost-effective than in the Western countries where adenocarcinoma is less prevalent [35,36]. Radiation exposure and risk of malignancy arising from the use of low-dose CT screening for lung cancer might be a major concern, but many screening trials showed that these related risks can be considered acceptable and even negligible considering the associated substantial mortality reduction [37].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Survival Outcomes of Lung Cancer: A Population-Based Study

Lin

Liu

et al. 2019

BioMed Research International

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Purpose. Lung cancer has been the top-ranking cause of cancer deaths in Taiwan for decades. Limited data were available in global cancer surveillance regarding lung cancer epidemiology in Taiwan, and previous reports are outdated. Patients and Methods. This population-based cohort study extracted data of patients with lung cancer from the Taiwan National Health Insurance database and determined the lung cancer incidence and prevalence during 2002–2014. Histological subtypes were retrieved from the Taiwan Cancer Registry database; survival rates were gathered from the National Death Registry. Average annual percentage changes (APCs) of prevalence, incidence, and overall survival were estimated by joinpoint regression analysis. Results. Age-standardized incidence of lung cancer increased from 45.04 per 100,000 person-years in 2002 to 49.86 per 100,000 person-years in 2014, with an average APC of 0.7 (95% CI = 0.3–1.1; 0.2 in males, 2.0 in females). Lung cancer was more prevalent in male patients, but this increase gradually slowed down. Socioeconomic analysis showed that lung cancer has higher prevalence in patients with higher income level and urban residency. Adenocarcinoma was the most abundant histological subtype in Taiwan (adenocarcinoma-to-squamous cell carcinoma ratio = 4.16 in 2014), with a 2.4-fold increase of incident cases during 2002–2014 (from 43.47% to 64.89% of all lung cancer cases). The 5-year survival rate of lung cancer patients in 2010 was 17.34% (12.60% in male, 25.40% in female), with an average APC of 9.3 (6.3 in male, 11.8 in female) during 2002–2010. Conclusion. Average APCs of prevalence and incidence of lung cancer were 3.1 and 0.7, respectively, during 2002–2014 in Taiwan. The number of female patients and number of patients with adenocarcinoma have increased the most, with incident cases doubling in these years. Facing this fatal malignancy, it is imperative to improve risk stratification, encourage early surveillance, and develop effective therapeutics for lung cancer patients in Taiwan.

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“…Each matched patient underwent follow-ups from the initiation of EGFR-TKI until September 2018 to verify the survival status. By using a semiparametric method explained in detail in our previous article [13], we extrapolated the survival to lifetime to estimate the life expectancy of patients receiving one of three first-line treatments. The extrapolation method has been shown to be effective via computer simulations [14], mathematical proof [15] and corroboration by examples of lung cancer cohorts [13,16,17].…”

Section: Effectivenessmentioning

confidence: 99%

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

et al. 2020

Self Cite

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IntroductionComparison of the effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors (TKIs) would improve patients' clinical benefits and save costs. Using realworld data, this study attempted to directly compare the effectiveness and cost-effectiveness of first-line afatinib, erlotinib, and gefitinib. MethodsDuring May 2011-December 2017, all patients with non-small cell lung cancer (NSCLC) visiting a tertiary center were invited to fill out the EuroQol five-dimension (EQ-5D) questionnaires and World Health Organization Quality of Life, brief version (WHOQOL-BREF), and received follow-ups for survival and direct medical costs. A total of 379 patients with EGFR mutation-positive advanced NSCLC under first-line TKIs were enrolled for analysis. After propensity score matching for the patients receiving afatinib (n = 48), erlotinib (n = 48), and gefitinib (n = 96), we conducted the study from the payers' perspective with a lifelong time horizon. ResultsPatients receiving afatinib had the worst lifetime psychometric scores, whereas the differences in quality-adjusted life expectancy (QALE) were modest. Considering 3 treatments together, afatinib was dominated by erlotinib. Erlotinib had an incremental cost-effectiveness of US$17,960/life year and US$12,782/QALY compared with gefitinib. Acceptability curves showed that erlotinib had 58.6% and 78.9% probabilities of being cost-effective given a threshold of 1 Taiwanese per capita GDP per life year and QALY, respectively.

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Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan

Abstract: Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.

Cited by 52 publications

References 32 publications

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

Epidemiology and Survival Outcomes of Lung Cancer: A Population-Based Study

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

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