Cost-effectiveness of Lung Cancer Screening Combining with CVD and COPD Screening: A Microsimulation Study

Abstract

Objective This study aims to estimate the cost-effectiveness of lung cancer (LC), cardiovascular disease (CVD), and chronic obstructive pulmonary disease (COPD), the so-called “big-3 diseases”, combining screening and identify the optimal target screening population in China. Methods A stage shift microsimulation model constructed and different screening strategies were set. Cost, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICER) and net health benefits (NHB) under different screening strategies were calculated. Strategies with a mean ICER less than $38,223 (3 times as much as China’s GDP per capita in 2022) were deemed to be cost-effective, and the optimal one in this case is the strategy with the largest NHB obtained at the same willingness to pay (WTP). One-way and probabilistic sensitivity analysis was conducted to estimate results’ stability. Results ICERs in all strategies ranged from $2,186.5 to 11,227.6 per QALY, which was less than China’s GDP per capita in 2022. This value was basically lower in combined screening for “big-3 diseases” than in screening for LC alone. The largest NHB and probability of cost-effectiveness were both obtained in the strategy with “big-3 diseases” screening for people over 45 years old with a smoking history of 20 pack-year at least. Conclusion The optimal target screening population should be current smokers or smoking quitters in the past 15 years, aged over 45 years old, with a smoking history of 20 pack-year at least. These findings may provide data support for the revision of lung cancer screening guidelines.