Cost of screening for lung cancer in Australia

Abstract

Background Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain. Aim To describe the first direct medical costs associated with lung cancer screening in Australia. Methods Single‐centre prospective screening cohort. Healthy volunteers (age 60–74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack‐years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values. Results A total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow‐up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non‐surgical median survival post‐diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false‐positive scan work‐up; AU$96 340 true‐positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow‐up post‐treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non‐surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care). Conclusions Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.

Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes

“…The number of LC cases was estimated from the number of LC deaths by applying 5-year survival. 5-year survival Cost of LDCT scan Australian MBS fee $302 Average cost of follow-up CT QLCSS [ 26 ] $476 Cost false positive QLCSS [ 26 ]. Non-CT work-up $861.8 Costs of LC management by stage Health-system costs based on the 45 and up study [ 25 ] (inclusive of pre-diagnosis costs) Stage I: $62,327; Stage II: $69,235; Stage III: $63,436; Stage IV: $56,701; Stage “unknown”: $38,388 Cost pre-diagnosis Health-system costs based on the 45 and up study [ 25 ].…”

Diagnosis and treatment of early lung cancer

“…8 In Australia, it has been shown that that high-quality LDCT screening is feasible and that long-term smoking cessation in a CT screening population is effective; the costs of screening and associated impacts on quality of life have also been reported. [9][10][11] The International Lung Screen Trial is currently underway within Australia to assess the benefits of risk prediction models for patient selection to improve the efficiency of CT screening. A 2013 Australian survey of 90 patients at risk of lung cancer found the majority would be willing to participate in screening with LDCT.…”

Time to acute stroke treatment in‐hours was more than halved after the introduction of the Helsinki Model at Westmead Hospital

“…This eligibility window may widen further still in light of the recent studies demonstrating the efficacy of acute intervention in selected patients at times longer than 6 h after symptom onset. [16][17][18] Despite the increase in stroke calls, there were also significantly fewer patients who received thrombolysis following the protocol change. Interestingly, more patients in the post-intervention group were ineligible for thrombolysis due to the presence of contraindications.…”