Risk Model–Based Lung Cancer Screening

Toumazis, Iakovos; Cao, Pianpian; Nijs, Koen de; Bastani, Mehrad; Munshi, Vidit; Hemmati, Mehdi; Haaf, Kevin ten; Jeon, Jihyoun; Tammemägi, M.; Gazelle, G. Scott; Feuer, Eric J.; Kong, Chung Yin; Meza, Rafael; Koning, Harry J. de; Plevritis, Sylvia K.; Han, Summer S.

doi:10.7326/m22-2216

Cited by 16 publications

(26 citation statements)

References 64 publications

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“…Previously published estimates of the cost-effectiveness of CT screening for LC have mostly focused on the US setting or considered only PY-based eligibility. 9,10,[19][20][21][22][23][24] Recently, the Swiss Cancer Screening Committee (CSC) issued a recommendation in favour of LC screening. 25 Pending a reimbursement decision, the committee suggests biennial screening focusing on younger populations (eg, 55-80 years rather than 60-85 years) with moderate smoking histories (eg, smokers from 20 PYs and including ex-smokers), without a specific recommendation for a risk-or PY-threshold.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of risk‐based low‐dose computed tomography screening for lung cancer in Switzerland

Tomonaga,

de Nijs,

Bucher

et al. 2023

Intl Journal of Cancer

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Throughout Europe, computed tomography (CT) screening for lung cancer is in a phase of clinical implementation or reimbursement evaluation. To efficiently select individuals for screening, the use of lung cancer risk models has been suggested, but their incremental (cost‐)effectiveness relative to eligibility based on pack‐year criteria has not been thoroughly evaluated for a European setting. We evaluate the cost‐effectiveness of pack‐year and risk‐based screening (PLCOm2012 model‐based) strategies for Switzerland, which aided in informing the recommendations of the Swiss Cancer Screening Committee (CSC). We use the MISCAN (MIcrosimulation SCreening ANalysis)‐Lung model to estimate benefits and harms of screening among individuals born 1940 to 1979 in Switzerland. We evaluate 1512 strategies, differing in the age ranges employed for screening, the screening interval and the strictness of the smoking requirements. We estimate risk‐based strategies to be more cost‐effective than pack‐year‐based screening strategies. The most efficient strategy compliant with CSC recommendations is biennial screening for ever‐smokers aged 55 to 80 with a 1.6% PLCOm2012 risk. Relative to no screening this strategy is estimated to reduce lung cancer mortality by 11.0%, with estimated costs per Quality‐Adjusted Life‐Year (QALY) gained of €19 341, and a €1.990 billion 15‐year budget impact. Biennial screening ages 55 to 80 for those with 20 pack‐years shows a lower mortality reduction (10.5%) and higher cost per QALY gained (€20 869). Despite model uncertainties, our estimates suggest there may be cost‐effective screening policies for Switzerland. Risk‐based biennial screening ages 55 to 80 for those with ≥1.6% PLCOm2012 risk conforms to CSC recommendations and is estimated to be more efficient than pack‐year‐based alternatives.

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Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of risk‐based low‐dose computed tomography screening for lung cancer in Switzerland

Tomonaga,

de Nijs,

Bucher

et al. 2023

Intl Journal of Cancer

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“…Furthermore, the cumulative potential life-years gained in individuals diagnosed with lung cancer was significantly higher with a PLCO m2012 threshold of greater than 1.70% at 6 years than in patients selected based on USPSTF-2013 criteria. A recent microsimulation analysis also suggests that risk model-based screening strategies are more cost-effective than the USPSTF-2021 recommendation [44 ▪ ]. In particular, strategies using a 6-year risk threshold of 1.2% or greater for PLCO m2012 (or 1.1% or greater for LCDRAT) had incremental cost-effectiveness ratios (ICERs) less than $100 000 per quality-adjusted life-year (QALY).…”

Section: Identification Of High-risk Individualsmentioning

confidence: 99%

Impact of low-dose computed tomography screening on lung cancer incidence and outcomes

Vachani

Caruso

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewTo review findings from clinical trials of lung cancer screening (LCS), assess contemporary issues with implementation in clinical practice, and review emerging strategies to increase the uptake and efficiency of LCS. Recent findingsIn 2013, the USPSTF recommended annual screening for individuals aged 55--80 years and currently smoke or quit within the past 15 years based on reduced mortality from lung cancer with annual low-dose computed tomography (LDCT) screening in the National Lung Screening Trial. Subsequent trials have demonstrated similar mortality outcomes in individuals with lower pack-year smoking histories. These findings, coupled with evidence for disparities in screening eligibility by race, resulted in updated guidelines by USPSTF to broaden eligibility criteria for screening. Despite this body of evidence, implementation in the United States has been suboptimal with fewer than 20% of eligible individuals receiving a screen. Barriers to efficient implementation are multifactorial and include patient, clinician, and system-level factors.

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“…Lung cancer screening based on an individual’s personal lung cancer risk (risk model–based screening) is more cost‐ effective than screening based on categorical age and smoking history according to a team of researchers for the Lung Working Group of the Cancer Intervention and Surveillance Modeling Network. The study was recently published in the Annals of Internal Medicine 1 …”

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confidence: 99%

“…“Risk model–based screening is cost‐effective under a wide range of risk thresholds, offers flexibility in implementation across different settings, and warrants further consideration,” concluded the authors 1 …”

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confidence: 99%