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

Abstract

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.

Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

“…We conducted univariate sensitivity analyses to assess the most influential parameters. All parameters were varied across plausible ranges: we used 95% confidence intervals (CIs) of empirical estimates and, where 95% CIs were unavailable, we employed ranges of +/-20% for probabilities and +/-50% for costs [29][30][31]. We also conducted probabilistic sensitivity analyses using Monte Carlo simulation to assess overall model parameter uncertainty and to further test the robustness of the results.…”

Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 – Key Elements for Programmatic Implementation of Lung Cancer Screening

“…Additional, but only occasionally needed resources included pulmonologists in their own practice seeing those needing individual workup, as well as hospital personnel in case of scheduled thoracoscopic biopsy during a 3-4-day stay at a hospital for chest diseases. When compared to standard clinical care, screening comes at considerable costs, even when balanced against possibly reduced expenses for, e. g., additional radiotherapy or expensive drug treatment [41][42][43][44]. Whether or not society is willing to bear these costs is a pending discussion.…”

ESR/ERS statement paper on lung cancer screening

“…An analysis of the NLST data estimated that the cost of LCS would be USD 81 000 per QALY gained [23], which is well below the threshold considered reasonable in the USA of USD 100 000 per QALY gained. Further CEAs performed in Canada and in a number of European countries [146,147] indicate that LCS can be cost-effective in different healthcare systems, depending on factors such as inclusion criteria, algorithms for positive screen results, screening intervals and tobacco cessation interventions [10,23,145,148,149]. A CEA from the public payer's perspective indicates that LDCT screening in high-risk participants is associated with an ICER well below the one accepted by health institutions such as the UK National Institute for Health and Care Excellence [150].…”