Lung Cancer Screening With Low-Dose Computed Tomography: Costs, National Expenditures, and Cost-Effectiveness

Goulart, Bernardo H. L.; Bensink, Mark; Mummy, David; Ramsey, Scott D.

doi:10.6004/jnccn.2012.0023

Cited by 100 publications

(68 citation statements)

References 24 publications

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“…Beyond the cost of the low-dose CT, the cost of further follow-up and evaluation in case of positive findings such as PET-CT, biopsies and surgical interventions, as well as emotional distress and loss of working days need to be measured. According to a recent analysis by the Research and Economic Assessment of Cancer and Healthcare (REACH), low-dose CT screening will add $1.3-2.0 billion in annual national healthcare expenditure for screening uptake rates of 50-75%, respectively [104]. It is estimated that at a 75% screening rate, low-dose CT screening will prevent up to 8100 premature lung cancer deaths.…”

Section: In Summarymentioning

confidence: 99%

Screening for lung cancer: time for large-scale screening by chest computed tomography

Shlomi

Ben-Avi

Balmor³

et al. 2014

European Respiratory Journal

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Lung cancer is the leading cause of cancer death worldwide. Age and smoking are the primary risk factors for lung cancer. Treatment based on surgical removal in the early stages of the disease results in better survival. Screening programmes for early detection that used chest radiography and sputum cytology failed to attain reduction of lung cancer mortality. Screening by low-dose computed tomography (CT) demonstrated high rates of early-stage lung cancer detection in a high-risk population. Nevertheless, no mortality advantage was manifested in small randomised control trials. A large randomised control trial in the USA, the National Lung Screening Trial (NLST), showed a significant relative reduction of 20% in lung cancer mortality and 6.7% reduction in total mortality, yet no reduction was evidenced in the late-stage prevalence. Screening for lung cancer by low-dose CT reveals a high level of false-positive lesions, which necessitates further noninvasive and invasive evaluations. Based primarily on the NLST eligible criteria, new guidelines have recently been developed by major relevant organisations. The overall recommendation coming out of this collective work calls for lung cancer screening by low-dose CT to be performed in medical centres manned by specialised multidisciplinary teams, as well as for a mandatory, pre-screening, comprehensive discussion with the patient about the risks and advantages involved in the process. Lung cancer screening is on the threshold of a new era, with ever more questions still left open to challenge future studies. @ERSpublications Lung cancer screening is on the threshold of a new era, with wider application of CT screening now recommended

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Section: In Summarymentioning

confidence: 99%

Screening for lung cancer: time for large-scale screening by chest computed tomography

Shlomi

Ben-Avi

Balmor³

et al. 2014

European Respiratory Journal

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“…The large variations noted among the existing estimates have prohibited researchers and policymakers from drawing a firm conclusion regarding the cost-effectiveness of LDCT screening. [11][12][13][14][15][16] Based on the number needed to screen to prevent 1 death from lung cancer in the NLST, Goulart et al estimated that the additional cost of LDCT screening to avoid 1 lung cancer death is $240,000.…”

Section: Discussionmentioning

confidence: 99%

Annual number of lung cancer deaths potentially avertable by screening in the United States

Ward

Smith

et al. 2013

Cancer

176

128

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BACKGROUND:The National Lung Screening Trial (NLST), which was conducted between 2002 and 2009, demonstrated that screening with low-dose computed tomography (LDCT) reduced lung cancer mortality by 20% among screening-eligible populations compared with chest x-ray. In this article, the authors provide an estimate of the annual number of lung cancer deaths that can be averted by screening, assuming the screening regimens adopted in the NLST are fully implemented in the United States. METHODS: The annual number of lung cancer deaths that can be averted by screening was estimated as a product of the screening effect, the US population size (obtained from the 2010 US Census data), the prevalence of screening eligibility (estimated using the 2010 National Health Interview Survey [NHIS] data), and the lung cancer mortality rates among screening-eligible populations (estimated using the NHIS data from 2000-2004 and the third National Health and Nutrition Examination Survey linked mortality files). Analyses were performed separately by sex, age, and smoking status, with Poisson regression analysis used for mortality rate estimation. Uncertainty of the estimates of the number of avertable lung cancer deaths was quantified by simulation. RESULTS: Approximately 8.6 million Americans (95% confidence interval [95% CI], 8.0 million-9.2 million), including 5.2 million men (95% CI, 4.8 million-5.7 million) and 3.4 million women (95% CI, 3.0 million -3.8 million), were eligible for lung cancer screening in 2010. If the screening regimen adopted in the NLST was fully implemented among these screening-eligible US populations, a total of 12,250 (95% CI, 10,170-15,671) lung cancer deaths (8990 deaths in men and 3260 deaths in women) would be averted each year. CONCLUSIONS: The data from the current study indicate that LDCT screening could potentially avert approximately 12,000 lung cancer deaths per year in the United States. Further studies are needed to estimate the number of avertable lung cancer deaths and the cost-effectiveness of LDCT screening under different scenarios of risk, various screening frequencies, and various screening uptake rates.

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“…4 Currently, 7 million Americans meet the National Lung Screening Trial screening criteria. 4,5 Even if only one-fourth of those eligible are screened, a possible 680,000 new nodules could be discovered over 3 years.Background: An estimated 150,000 pulmonary nodules are identifi ed each year, and the number is likely to increase given the results of the National Lung Screening Trial. Decision tools are needed to help with the management of such pulmonary nodules.…”

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confidence: 99%

mentioning

confidence: 99%

The Utility of Nodule Volume in the Context of Malignancy Prediction for Small Pulmonary Nodules

Mehta

Ravenel

Shaftman

et al. 2014

Chest

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When faced with a patient with a pulmonary nodule, it is incumbent on the clinician to differentiate benign cases from cancer. Although most clinicians use clinical experience to estimate the probability of malignancy in pulmonary nodules, some rely on one or T he pulmonary nodule is a single, spherical, wellcircumscribed, radiographic opacity that measures , 3 cm in diameter and is completely surrounded by aerated lung. There is no associated atelectasis, hilar enlargement, or pleural effusion. 1 Approximately 150,000 such nodules are identifi ed each year according to dated estimates. 2,3 The incidence is likely much higher than this because of the increasing use of chest CT scan for the evaluation of a myriad of pulmonary symptoms and disorders. The National Lung Screening Trial has shown screening patients with low-dose CT (LDCT) scanning led to a relative risk reduction in death from lung cancer by 20%. 4 Over the 3-year screening period, however, 39.1% of the participants in the LDCT scanning group had a nodule discovered, of which (96.4%) were benign. 4 Currently, 7 million Americans meet the National Lung Screening Trial screening criteria. 4,5 Even if only one-fourth of those eligible are screened, a possible 680,000 new nodules could be discovered over 3 years.Background: An estimated 150,000 pulmonary nodules are identifi ed each year, and the number is likely to increase given the results of the National Lung Screening Trial. Decision tools are needed to help with the management of such pulmonary nodules. We examined whether adding any of three novel functions of nodule volume improves the accuracy of an existing malignancy prediction model of CT scan-detected nodules. Methods: Swensen's 1997 prediction model was used to estimate the probability of malignancy in CT scan-detected nodules identifi ed from a sample of 221 patients at the Medical University of South Carolina between 2006 and 2010. Three multivariate logistic models that included a novel function of nodule volume were used to investigate the added predictive value. Several measures were used to evaluate model classifi cation performance. Results: With use of a 0.5 cutoff associated with predicted probability, the Swensen model correctly classifi ed 67% of nodules. The three novel models suggested that the addition of nodule volume enhances the ability to correctly predict malignancy; 83%, 88%, and 88% of subjects were correctly classifi ed as having malignant or benign nodules, with signifi cant net improved reclassifi cation for each ( P , .0001). All three models also performed well based on Nagelkerke R 2 , discrimination slope, area under the receiver operating characteristic curve, and Hosmer-Lemeshow calibration test. Conclusions:The fi ndings demonstrate that the addition of nodule volume to existing malignancy prediction models increases the proportion of nodules correctly classifi ed. This enhanced tool will help clinicians to risk stratify pulmonary nodules more effectively.CHEST 2014; 145(3):464-472

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Lung Cancer Screening With Low-Dose Computed Tomography: Costs, National Expenditures, and Cost-Effectiveness

Cited by 100 publications

References 24 publications

Screening for lung cancer: time for large-scale screening by chest computed tomography

Screening for lung cancer: time for large-scale screening by chest computed tomography

Annual number of lung cancer deaths potentially avertable by screening in the United States

The Utility of Nodule Volume in the Context of Malignancy Prediction for Small Pulmonary Nodules

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