Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: A registry study

Rasmussen, Jakob Fraes; Siersma, Volkert; Pedersen, Jesper Holst; Heleno, Bruno; Saghir, Zaigham; Brodersen, John

doi:10.1016/j.lungcan.2013.12.005

Cited by 35 publications

(30 citation statements)

References 23 publications

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“…Recurrence monitoring for NSCLC is based on both a clinical exam and imaging, which can be chest x-ray (CXR), computed tomography (CT), or positron emission tomography (PET) CT scan [11][12][13], with CT scans used most widely in the Western world [12,14]. However, there are limitations to all of these imaging techniques, including variations in sensitivity [14] and specificity [15], high costs [16,17], variable availability, and the risks associated with repeated exposure to radiation [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Muley

Rolny

et al. 2019

Lung Cancer

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The biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymis protein 4 (HE4) are useful in the diagnosis, prognosis, and monitoring of non-small cell lung cancer (NSCLC), but their combination has not been investigated yet. The objective of this analysis was to evaluate the ability of CYFRA 21-1 and HE4 to predict recurrence as part of follow-up monitoring in patients with adenocarcinoma (ADC) of the lung. Materials and methods: Serum samples were collected from patients with stage I-IIIA ADC preoperatively and during follow-up at 3, 6, 12, 18, and 24 months and then every 6-12 months up to 5 years post-R0 resection. Samples were analyzed for CYFRA 21-1 and HE4 via electrochemiluminescence immunoassay. All cases of disease recurrence were verified by imaging. The diagnostic performance of CYFRA 21-1, HE4, and their combination to predict recurrence was assessed by Receiver Operating Characteristic (ROC) and corresponding area under the curve (AUC). Results: 115 patients with ADC were included (N = 612 biomarker measurements); median age was 63 years; most had stage I-II disease (n = 97; 84.3%). All patients underwent surgical resection; 44 patients (38%) also received adjuvant chemotherapy and 16 (14%) received radiation therapy. At the median timepoint for the last blood sample collection (37 months), 31 patients (27%) had experienced recurrence. Both CYFRA 21-1 and HE4 were able to detect recurrence (AUC and 95% confidence interval [CI]): 75.9% (66.0-85.8%) and 75.4% (65.9-84.8%), respectively, but this increased with the combination (78.8% [69.0-88.6%]). At a sensitivity of 80%, the respective specificities (95% CI) for CYFRA 21-1, HE4, and the combination were 57.1% (53.0-61.2%), 57.1% (53.0-61.2%), and 69.7% (65.8-73.4%). Conclusion: Serial measurements of serum CYFRA 21-1 and HE4 levels could provide a valuable method for follow-up monitoring of patients with ADC to detect recurrence.

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Section: Introductionmentioning

confidence: 99%

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Muley

Rolny

et al. 2019

Lung Cancer

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“…An evaluation of the Danish Lung Cancer Screening Trial (DLCST) showed that mean annual healthcare expenditures were higher among subjects with false-positive screens (€4464) as compared with control-arm subjects (€2673) by a factor of 1.67 (95% CI: 1.20–2.32) [16]. Subjects with (true-) negative screens had similar expenditures to control subjects.…”

Section: Harms Of Screeningmentioning

confidence: 99%

Assessing the Benefits and Harms of Low-Dose Computed Tomography Screening For Lung Cancer

Pinsky¹

2014

Lung Cancer Manag.

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Summary The concept of using low-dose computed tomography (LDCT) for lung cancer screening goes back almost 25 years. In 2011, the National Lung Screening Trial (NLST) reported that LDCT screening significantly reduced mortality from lung cancer in a high risk population. This article evaluates the benefits and harms of LDCT screening, based largely on evidence from randomized trials. Harms include false-positive screens and resultant diagnostic procedures, overdiagnosed cancers, and radiation exposure. Benefits can be expressed as the number needed to be screened to prevent one lung cancer death or as estimated overall reductions in lung cancer mortality assuming LDCT population screening as recommended by guidelines. Indirect metrics of benefit, such as lung cancer survival and stage distribution, as well as measures of harms, will be important to monitor in the future as LDCT screening disseminates in the population.

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“…We currently have evidence from European modelling that lung cancer screening can be cost effective, if one bases this on individuals with specific high-risk profiles in individuals 55-75 years of age [10,25]. The Danish study on cost effectiveness demonstrated low-dose lung cancer CT screening increases healthcare costs compared with no screening; however, this difference was attributable to the costs of the CT screening programme [26]. Currently, we await the cost effectiveness data from the NELSON trial.…”

Section: Quality Assurance: Europe Should Set Up a Central Registry Fmentioning

confidence: 99%

EU Policy on Lung Cancer CT Screening 2017

Field

Zulueta²,

Veronesi

et al. 2017

Biomed Hub

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Background: Lung cancer kills more Europeans than any other cancer. In 2013, 269,000 citizens of the EU-28 died from this disease. Lung cancer CT screening has the potential to detect lung cancer at an early stage and improve mortality. All of the randomised controlled trials and cohort low-dose CT (LDCT) screening trials across the world have identified very early stage disease (∼70%); the majority of these LDCT trial patients were suitable for surgical interventions and had a good clinical outcome. The 10-year survival in CT screen-detected cancer was shown to be even higher than the 5-year survival for early stage disease in clinical practice at 88%. Methods: Setting up of an EU Commission expert group can be done under Article 168(2) of the Treaty on the Functioning of the European Union, to develop policy and recommendation for Lung cancer CT screening. The Expert Group would undertake: (a) assist the Commission in the drawing up policy documents, including guidelines and recommendations; (b) advise the Commission in the implementation of Union actions on screening and suggest improvements to the measures taken; (c) advise the Commission in the monitoring, evaluation and dissemination of the results of measures taken at Union and national level. Results: This EU Expert Group on lung cancer screening should be set up by the EU Commission to support the implementation and suggest recommendations for the lung cancer screening policy by 2019/2020. Conclusion: Reduce lung cancer in Europe by undertaking a well-organised lung cancer CT screening programme.

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Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: A registry study

Cited by 35 publications

References 23 publications

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Potential for the blood-based biomarkers cytokeratin 19 fragment (CYFRA 21-1) and human epididymal protein 4 (HE4) to detect recurrence during monitoring after surgical resection of adenocarcinoma of the lung

Assessing the Benefits and Harms of Low-Dose Computed Tomography Screening For Lung Cancer

EU Policy on Lung Cancer CT Screening 2017

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