Cost-effectiveness of low-dose CT screening for lung cancer in a European country with high prevalence of smoking—A modelling study

Tomonaga, Yuki; Haaf, Kevin ten; Frauenfelder, Thomas; Kohler, Malcolm; Kouyos, Roger D.; Shilaih, Mohaned; Lorez, Matthias; Koning, Harry J. de; Schwenkglenks, Matthias; Puhan, Milo A.

doi:10.1016/j.lungcan.2018.05.008

Cited by 53 publications

(88 citation statements)

References 28 publications

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“…Incorporating the adherence rate of the NLST (90%) for the screening cohort into our model (adherence in base case: 54%) would result in a 3.54% reduction of 5-year (all-cause) mortality. These findings are in line with Treskova et al and Tomonaga et al, who found lung cancer specific mortality reduction in German and Swiss screening settings to be substantially lower than that of the NLST [27,60].…”

Section: Discussionsupporting

confidence: 91%

“…The difference was attributable mainly to screening costs associated with the high number of CT scans in the screening cohort (9,398,585 over 15 years, see Table 2). Based on the assumption of an eligible population of 1,600,270 people in Germany, our simulation resulted in an incremental gain of 95,581 life years (60,906 QALYs) and an incremental budget impact of € 1.84 billion for the screening program over 15 years. The higher costs of screening were due to the screening itself (about 71% of the difference) but also to treatment (27%) and aftercare (2%) for substantially higher numbers of diagnoses at an early stage.…”

Section: Resultsmentioning

confidence: 99%

“…Whereas Treskova et al based their cost estimation on UK cost data, we chose to use claims data from a German statutory health insurer as reported and validated by Schwarzkopf et al Furthermore, Treskova et al assumed in their base case that a lung cancer screening sessions would cost €150, while we assumed a cost of € 99. A recently published cost-effectiveness study from Switzerland reported ICERs between € 24,972 and € 48,369 per life year gained and between € 35,674 and € 69,099 per QALY gained, depending on the evaluated screening scenario [60]. While Switzerland is comparable to Germany in terms of health care delivery, it is less so in terms of reimbursement rates and hence health care costs.…”

Section: Discussionmentioning

confidence: 99%

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Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

Hofer¹,

Kauczor

Stargardt³

2018

Lung Cancer

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Background: Lung cancer is the leading cause of cancer death in Germany. Although several randomized trials in Europe have evaluated the effectiveness of lung cancer screening programs, evidence on the cost-effectiveness of lung cancer screening is scarce. Objective: To evaluate the cost-effectiveness of a population-based lung cancer screening program from the perspective of a German payer. Methods: We conducted a cost-effectiveness analysis from the public payer perspective for a high-risk population defined as heavy former and current smokers (≥20 cigarettes per day) between 55 and 75 years of age. The underlying model consisted of two Markov models. We differentiated between a population-based annual screening program and standard clinical care. Depending on stage at diagnosis, simulated patients were assigned to one of five treatment paths according to the German clinical guideline for the diagnosis and treatment of lung cancer. Costs, life years saved, and quality adjusted life years (QALYs) were used as outcomes. Values for input parameters were taken from the literature. The model was run for 60 cycles with a cycle length of three months. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the base case, annual lung cancer screening led to an increase in incremental costs (€ 1,153 per person) compared to standard clinical care. However, the screening approach was associated with an incremental gain in life years (0.06 per person) and QALYs (0.04 per person). Thus, the incremental cost-effectiveness ratio (ICER) was € 19,302 per life year saved and € 30,291 per QALY. A probabilistic sensitivity analysis with 10,000 draws resulted in average ICERs of € 22,118 per life year and € 34,841 per QALY. Conclusion: We provide evidence that lung cancer screening for a high-risk population may be more effective, but also more costly, than standard clinical care from the perspective of a German payer.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

Hofer¹,

Kauczor

Stargardt³

2018

Lung Cancer

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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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“…Lung cancer is one of the major malignant tumors and characterized by high mortality throughout the world despite great development in diagnosis and treatments [1,2]. Several reports indicated that the five-year survival of lung cancer is no more than 20% [3,4].…”

Section: Introductionmentioning

confidence: 99%

Chinese Herbal Formulas Miao-Yi-Ai-Tang Inhibits the Proliferation and Migration of Lung Cancer Cells through Targetingβ-Catenin/AXIN and Presents Synergistic Effect with Cisplatin Suppressing Lung Cancer

Zhang

Tan

et al. 2020

BioMed Research International

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Objective. Lung cancer is one of the major causes of cancer deaths worldwide, and the five-year survival still remains low despite the improvement of screening, prevention, and treatment methods. Chinese herbal medicines have been widely used for tumor prevention and treatment. Miao-Yi-Ai-Tang (Miao) is a novel herbal formulation and shows a potential anticancer effect. Materials and Methods. Human Small Cell Lung Cancer Cell was used for study in vitro. After treatments by Miao and Cisplatin (DDP), the invasion, migration, proliferation, and apoptosis of cells were detected by transwell, wound healing, CCK-8, and flow cytometry, respectively. The expression of β-catenin, AXIN, and c-myc was detected by qRT-PCR and immunohistochemistry staining. Western blotting was applied for measuring the protein expression of β-catenin. Subcutaneously transplanted tumor model of lung cancer NCI-H446 was established to investigate the influence of Miao on tumor growth. Results. We found that Miao could inhibit invasion, migration, and proliferation and promote apoptosis of human lung cancer cells. Meanwhile, Miao and DDP presented synergy regulating the proliferation and apoptosis of lung cancer cells. The percentage of lung cancer cells in S and G2 stages was increased markedly by Miao. Besides, the expression of c-myc, AXIN, and β-catenin was markedly inhibited by Miao. Tumor growth in vivo was markedly inhibited by Miao. Conclusions. Chinese herbal formulas Miao could suppress lung cancer through targeting the β-catenin/AXIN signaling pathway. Therefore, our findings may provide a novel strategy for the prevention and treatment of lung cancer.

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Cost-effectiveness of low-dose CT screening for lung cancer in a European country with high prevalence of smoking—A modelling study

Cited by 53 publications

References 28 publications

Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

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

Chinese Herbal Formulas Miao-Yi-Ai-Tang Inhibits the Proliferation and Migration of Lung Cancer Cells through Targetingβ-Catenin/AXIN and Presents Synergistic Effect with Cisplatin Suppressing Lung Cancer

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