Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study

Zhao, Zixuan; Du, Lingbin; Li, Yuanyuan; Wang, Le; Wang, Youqing; Yang, Yi; Dong, Hengjin

doi:10.2196/36425

Cited by 6 publications

(9 citation statements)

References 33 publications

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“…In this modelling study, the Markov model on lung cancer screening that developed by our previous work was used and adapted for the purpose of assessing the potential impact of LDCT screening with and without a PRS from a societal perspective. Important assumptions and the overall structure of the model have been thoroughly described before and in supplementary material [ 19 , 20 ]. Per China guideline for the screening and early detection of lung cancer (2021,Beijing) [ 21 ] recommended, 3 hypothetical cohorts of 10,000 current and former smokers aged 50–74 years old were simulated until death or age 79 years (mean life expectancy in China),named non-screening cohort, LDCT screening cohort and LDCT&PRS screening cohort.…”

Section: Methodsmentioning

confidence: 99%

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

Zhao,

Gu,

Yang

et al. 2024

BMC Cancer

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Introduction Several studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear. Methods The comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50–74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted. Results The strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50–74 years. The strategy that screened using LDCT alone from 70–74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone. Conclusion The PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

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Section: Methodsmentioning

confidence: 99%

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

Zhao,

Gu,

Yang

et al. 2024

BMC Cancer

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“…A recent Chinese study by Zhao Z. investigated the cost-effectiveness of lung cancer screening among heavy smokers by incorporating the start age and screening interval [79]. The scholars revealed that a lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for individuals with smoking habits aged 55-74 years, along with one-time screening for those aged 65-74 years.…”

Section: Yes For Japanmentioning

confidence: 99%

Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation

et al. 2023

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Lung cancer is the leading cause of cancer-related deaths in Europe, with low survival rates primarily due to late-stage diagnosis. Early detection can significantly improve survival rates, but lung cancer screening is not currently implemented in Italy. Many countries have implemented lung cancer screening programs for high-risk populations, with studies showing a reduction in mortality. This review aimed to identify key areas for establishing a lung cancer screening program in Italy. A literature search was conducted in October 2022, using the PubMed and Scopus databases. Items of interest included updated evidence, approaches used in other countries, enrollment and eligibility criteria, models, cost-effectiveness studies, and smoking cessation programs. A literature search yielded 61 scientific papers, highlighting the effectiveness of low-dose computed tomography (LDCT) screening in reducing mortality among high-risk populations. The National Lung Screening Trial (NLST) in the United States demonstrated a 20% reduction in lung cancer mortality with LDCT, and other trials confirmed its potential to reduce mortality by up to 39% and detect early-stage cancers. However, false-positive results and associated harm were concerns. Economic evaluations generally supported the cost-effectiveness of LDCT screening, especially when combined with smoking cessation interventions for individuals aged 55 to 75 with a significant smoking history. Implementing a screening program in Italy requires the careful consideration of optimal strategies, population selection, result management, and the integration of smoking cessation. Resource limitations and tailored interventions for subpopulations with low-risk perception and non-adherence rates should be addressed with multidisciplinary expertise.

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“…Third, risk-stratified screening intervals should be further refined. Despite many studies comparing different screening intervals, only the population as a whole was analyzed, and the focus was on stratification to either annual, biennial, or triennial screening [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

Liu,

Xu,

et al. 2024

BMC Med

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Background Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals. Methods We conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained. Results Compared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened. Conclusions Risk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit–harm trade-offs and improve the cost-effectiveness of lung cancer screenings.

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Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study

Cited by 6 publications

References 33 publications

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation

Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study

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