Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

McLeod, Melissa; Sandiford, Peter; Kvizhinadze, Giorgi; Bartholomew, Karen

doi:10.1136/bmjopen-2020-037145

Cited by 18 publications

(14 citation statements)

References 40 publications

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“…For example, Yuan et al used a discount rate of 3%, while a rate of 5% was adopted in this study in accordance with the China Guidelines for Pharmacoeconomic Evaluations [ 29 ], and staging was simplified in the Markov model by ignoring the CIS stage. For comparison between annual screening and nonscreening, the ICER of 119,974 to 245,746 CNY in this study is comparable to previous estimates of US $24,934, US $49,200-96,700, and US $33,825 per QALY gained reported by studies conducted in New Zealand, the United States, and Canada, respectively [ 30 - 32 ].…”

Section: Discussionsupporting

confidence: 84%

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

Zhao¹,

Du²,

Li³

et al. 2022

JMIR Public Health Surveill

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Background Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer–specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. Objective This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. Methods A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer–specific mortality, with future costs and outcomes discounted by 5%. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. Results The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer–related mortality of 0.004%-1.171% and 6.189%-15.819%, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. Conclusions This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program.

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Section: Discussionsupporting

confidence: 84%

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

Zhao¹,

Du²,

Li³

et al. 2022

JMIR Public Health Surveill

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“…Unfortunately, at least with respect to the cancer types included in the current study, lung cancer leads the way with respect to stigma, with patients not only attracting higher levels of blame but also higher levels of avoidance. Recently, in a promising step, following a costbenefit analysis [27], the Health Research Council of New Zealand funded the very first trial of lung cancer screening in Aotearoa New Zealand [28]. Screening programmes, however, are not immune to stigma.…”

Section: Discussionmentioning

confidence: 99%

Lung Cancer Attracts Greater Stigma than Other Cancer Types in Aotearoa New Zealand

Godward

Riordan

Winter

et al. 2022

Journal of Oncology

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Background. Lung cancer is the leading cause of cancer death in Aotearoa New Zealand, killing over 1,700 people each year. Despite the burden of lung cancer in Aotearoa New Zealand, the popular press has referred to it as the cancer type that no one talks about. Here, we investigate one factor that may contribute to this state of affairs: lung cancer stigma. Methods. Participants were university students and members of the general public. University students were recruited via an online experiment participation system in 2021. Members of the public were recruited via social media. All participants completed the Cancer Stigma Scale (CSS) for one of five cancer types (lung, cervical, breast, skin, or bowel). The CSS is a 25-item scale with six subscales: awkwardness, avoidance, severity, policy opposition, personal responsibility, and financial discrimination. Results. The mean age of participants was 24.3 (Standard Deviation = 10.4). Data from each subscale were submitted to an analysis of covariance (ANCOVA), with cancer type as a between-participant factor (5: lung, cervical, breast, skin, or bowel) and stigma as the dependent variable. Relative to most other cancer types, people were more likely to avoid someone with lung cancer, view interacting with someone with lung cancer as more awkward, and view people with lung cancer as being responsible for their condition. Conclusion. The Health Research Council of New Zealand recently funded the very first trial of lung cancer screening in Aotearoa New Zealand. The current study suggests that addressing stigma will be essential for the success of such programs, with stigma likely influencing those who engage in such trials.

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“…Note that the latter approach implies a common strategy for all those screened. For example, McLeod et al stratify by ethnicity and sex, considering the cost-effectiveness of screening in four separate subgroup analyses of Māori and non-Māori men and women, respectively [ 50 ]. Conversely, Tomonaga et al consider various policies over a range of alternative eligibility criteria corresponding with those in the NLST and NELSON trials within a single analysis [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

“…In total, 16 (48%) studies present ACERs rather than ICERs [25,30,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]]. An additional 6 (18%) studies estimate ICERs of annual screening without assessment against biennial comparators [28,[32][33][34][35][36].…”

Section: Comparisons and Cost-effectiveness Ratiosmentioning

confidence: 99%

Cost-Effectiveness Analyses of Lung Cancer Screening Using Low-Dose Computed Tomography: A Systematic Review Assessing Strategy Comparison and Risk Stratification

Fabbro

Hahn

Novaes

et al. 2022

PharmacoEconomics Open

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Objectives Our first study objective was to assess the range of lung cancer screening intervals compared within cost-effectiveness analyses (CEAs) of low-dose computed tomography (LDCT) and to examine the implications for the strategies identified as optimally cost effective; the second objective was to examine if and how risk subgroup-specific policies were considered. Methods PubMed, Embase and Web of Science were searched for model-based CEAs of LDCT lung screening. The retrieved studies were assessed to examine if the analyses considered sufficient strategy variation to permit incremental estimation of cost effectiveness. Regarding risk selection, we examined if analyses considered alternative risk strata in separate analyses or as alternative risk-based eligibility criteria for screening. ResultsThe search identified 33 eligible CEAs, 23 of which only considered one screening frequency. Of the 10 analyses considering multiple screening intervals, only 4 included intervals longer than 2 years. Within the 10 studies considering multiple intervals, the optimal policy choice would differ in 5 if biennial intervals or longer had not been considered. Nineteen studies conducted risk subgroup analyses, 12 of which assumed that subgroup-specific policies were possible and 7 of which assumed that a common screening policy applies to all those screened. Conclusions The comparison of multiple strategies is recognised as good practice in CEA when seeking optimal policies. Studies that do include multiple intervals indicate that screening intervals longer than 1 year can be relevant. The omission of intervals of 2 years or longer from CEAs of LDCT screening could lead to the adoption of sub-optimal policies. There also is scope for greater consideration of risk-stratified policies which tailor screening intensity to estimated disease risk. Policy makers should take care when interpreting current evidence before implementing lung screening.

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Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis

Cited by 18 publications

References 40 publications

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

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

Lung Cancer Attracts Greater Stigma than Other Cancer Types in Aotearoa New Zealand

Cost-Effectiveness Analyses of Lung Cancer Screening Using Low-Dose Computed Tomography: A Systematic Review Assessing Strategy Comparison and Risk Stratification

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