Randomized controlled trials of the efficacy of lung cancer screening by sputum cytology revisited

Abstract

Objective To estimate the long‐term direct medical costs and health care utilization for patients with systemic lupus erythematosus (SLE) and a subset of SLE patients with nephritis. Methods Patients with newly active SLE were found in the MarketScan Medicaid Database (1999–2005), which includes all inpatient, outpatient, emergency department, and pharmaceutical claims for more than 10 million Medicaid beneficiaries. The date a patient became newly active was defined as the earliest observed SLE diagnosis code, with a 6‐month clean period prior to the diagnosis. This method identified 2,298 patients with a consecutive followup of 5 years. A reference group of patients without SLE was constructed using propensity score matching. Nephritis was assessed based on diagnosis and procedure codes involving the kidney. Results Mean annual medical costs for SLE patients totaled $16,089 at year 1, which is significantly greater (by $6,831) than that for reference patients. Costs decreased slightly at year 2 but then increased yearly at an average rate of 16% through year 5, to $23,860. SLE patients without nephritis (n = 1,809) had costs $967–3,756 higher than the reference patients. SLE patients with nephritis (n = 489) had costs $13,228–34,907 greater than the reference group. Inpatient visits for the nephritis subgroup were 0.6–1.0 per capita, which are approximately twice the rate for all SLE patients and 3 to 4 times higher than the reference group. Conclusion SLE is a costly condition to treat. Medical expenses incurred by SLE patients increase steadily over time, particularly for patients with nephritis.

Systematic Review, Meta-Analysis and Randomized Controlled Trials in Cytopathology

“…Exfoliate cytopathology focused on urine and cyst fluid. In contrast to GC, cytopathologists performed RCTs, SRs and MAs in NG and FNA cytology more frequently than clinicians [44,45,46,47,48,49,50,51,52,53]. …”

“…Most of the gynecology studies focused on comparisons between liquid-based cytology and conventional Pap smears, human papilloma virus (HPV) testing, rapid prescreen review, and collection devices of cervical smears. The focus of RCTs, SR and MA in FNA practice was on respiratory, thyroid and pancreatic lesions [44,45,46,47,48,49,50,51,52,53]. They also compared FNA with tissue biopsy and frozen section.…”

“…Fifty-three RCTs, 30 SR/MA and 3 Cochrane reviews in cytology were found (table 1) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]. The initial database search identified 150 potentially relevant abstracts of which 122 articles were retrieved in full texts.…”

Lung cancer screening: from imaging to biomarker

“…The JHLP study randomized 10,386 participants and noted 194 cases of lung cancer in the screening group compared to 202 cases in the control group. Akin to the MSKLP trial, the final results of JHLP showed no differences in overall survival or disease-specific mortality between the study groups [14-16]. …”

Use of Lung Cancer Screening Tests in the United States: Results from the 2010 National Health Interview Survey

“…Further, while lung cancer has an overall 5-year survival of only 16 percent, it has a better prognosis (5-year survival 52 percent) when detected at a localized stage (2). However, randomized controlled trials (RCT) initiated in the 1970s failed to demonstrate a reduction in lung cancer mortality in individuals screened by more versus less intensive regimens of chest x-ray and/or sputum cytology ((3–5), reviewed in (6)). More recently, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial found no benefit of chest x-ray screening in reducing lung cancer mortality, as compared to usual care (7).…”