scholarly journals Can we increase efficiency of CT lung cancer screening by combining with CVD and COPD screening? Results of an early economic evaluation

2022 ◽  
Author(s):  
Carina M. Behr ◽  
Hendrik Koffijberg ◽  
Koen Degeling ◽  
Rozemarijn Vliegenthart ◽  
Maarten J. IJzerman
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Screening Program ◽  
Cost Effective ◽  
Economic Viability ◽  
Chronic Obstructive ◽  
Screening Population ◽  
Target Screening

Abstract Objectives Estimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC. Methods A model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50–75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts. Results The MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD. Conclusions The economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective. Key Points • Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50–75 years is potentially cost-effective if screening would cost less than €971 per screened individual. • Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population. • With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective.

scholarly journals Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
John R. Goffin ◽  
Gregory R. Pond ◽  
Serge Puksa ◽  
Alain Tremblay ◽  
Michael Johnston ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
High Prevalence ◽  
Screening Population

Abstract Background Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008)

scholarly journals Care Burden Derived from the Introduction of an Early Lung Cancer Screening Program in High-Risk HIV-Infected Patients

2019 ◽  
Vol 18 ◽  
pp. 232595821983907 ◽  
Author(s):  
Simona Cioaia ◽  
Carlos Tornero ◽  
Eugenio Sanchez ◽  
Mariajose Alos
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Care Burden ◽  
Computed Tomographic ◽  
Cancer Screening Program ◽  
Lung Cancer Screening Program

We describe the care burden derived from a lung cancer screening program in high-risk patients with HIV. In a well-selected group with the described criteria, one annual low-dose thoracic computed tomographic exploration can be applied to 7.2% of the patients attended (95% confidence interval: 4.2-9.6), with at least one follow-up exploration in another 1.3%, with the generation of at least 2 extra visits for explanation of the protocol and results. If smoking habit does not change over the next 2 years, another 4.3% of the patients will have met the inclusion criteria. Early detection of lung cancer with low-dose thoracic computed tomographic could be of interest in HIV-infected patients because of the increased of risk but would imply an increase in care burden that must be taken into account.

scholarly journals Cost-effectiveness analysis of low-dose computed tomography screening for lung cancer in Hungary

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Z Voko ◽  
A Molnar ◽  
V Valay ◽  
M Moizs ◽  
A Kerpel-Fronius ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Low Dose ◽  
Screening Programme ◽  
Risk Group ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
Low Dose Computed Tomography

Abstract Background Hungary has the highest incidence of lung cancer in the world (GLOBOCAN, 2018). Since lung cancer is rarely treatable in its advanced stage, one possible way to reduce mortality is early diagnosis and subsequent treatment. The possibility and necessity of introducing low-dose computed tomography (LDCT) lung cancer screening as a public health programme is a current and relevant health policy issue. Methods A Markov cohort model was built to assess the cost-effectiveness of such a risk group screening programme in Hungary. The model was populated with transition probabilities and resource utilization data derived from the HUNCHEST Hungarian lung cancer screening trial. The model results are presented in incremental cost-effectiveness ratio. Results A closed cohort of 10,000 smokers with the average starting age of 59 years was followed over life-time horizon and screened for lung cancer annually until the age of 74. Compared to the current scenario of no organized lung cancer screening in Hungary, the model resulted in an additional 0.1614 life-year gained per individual and an additional 0.2924 disease-free life-year gained per individual with annual screening frequency. The incremental cost-effectiveness ratio was EUR 608 indicating that assessed intervention is cost-effective in the analyzed setting. Sensitivity analyses confirmed the robustness of the model results. Conclusions Results suggest that introducing low-dose computed tomography screening for lung cancer is a cost-effective intervention in Hungary. Considering the exceptionally high incidence and mortality of lung cancer in Hungary, the population could benefit from such a risk group screening programme. Key messages Low-dose computed tomography screening for lung cancer is cost-effectiveness in the Hungarian setting. Policy makers are encouraged to consider the introduction of a risk group screening programme.

scholarly journals P1.01-036 Lung Cancer Screening Program Is Cost Effective in French Setting: A Model Based Study

2017 ◽  
Vol 12 (1) ◽  
pp. S470-S471
Author(s):  
Christos Chouaid ◽  
Juliette Vella-Boucaud ◽  
Jean Claude Pairon ◽  
Anne Duburcq ◽  
Bruno Detournay ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
Model Based ◽  
Cancer Screening Program ◽  
Lung Cancer Screening Program

Potential barriers to lung cancer screening in a minority population: Assessing attitudes, beliefs, and values towards screening with low-dose computed tomography amongst a high-risk minority population.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 17-17
Author(s):  
Richard Stephen Sheppard ◽  
Stefani Beale ◽  
Janet Joseph ◽  
Sai Santhoshini Achi ◽  
Abosede Showunmi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Minority Populations ◽  
Minority Population ◽  
Potential Barriers ◽  
Beliefs And Values ◽  
Low Dose Computed Tomography

17 Background: While the National Lung Screening Trial (NLST) has shown a relative reduction in mortality from lung cancer with the application of the United States Preventative Services Task Force (USPSTF) guidelines for the use of Low-Dose Computed Tomography (LDCT) in a select high risk population, many studies have shown that the rate of screening has been below the national average in minority population. Furthermore, lung cancer mortality still appears to be disproportionately higher amongst minority populations. With this study, we aim to evaluate the attitudes, beliefs and values towards lung cancer screening with LDCT in a predominantly Black and Hispanic population in our outpatient clinic. Methods: A survey was conducted over a 3-month period in our outpatient department at an urban inner-city safety net hospital. We included high risk smokers, aged 50 to 80 years who reported no evidence of symptoms. The survey consisted of 20 questions; these included utilizing the Health Belief Model to assess beliefs on perceived susceptibility, severity, benefits and barriers to screening, questions exploring fears of cancer screening and questions assessing overall willingness to undergo lung cancer screening with LDCT. We also included a question on the willingness of participants to engage in educational sessions with regards to lung cancer screening and risk reduction. Results were collected and analyzed via univariate logistic regression model to compare patient populations. Results: 67 patients participated in our survey. 62% were Black, 34% were Hispanic and 4% were Asian/Pacific Islanders. The mean age of our population was 64.5 years and they had an average of 27.2 pack-years of smoking. Issues related to insurance coverage and co-pay were identified as the most significant concern with regards to the unwillingness to undergo screening (p < 0.05). Other concerns identified were the fear of a positive screening result, fear of radiation exposure and lack of understanding of the association with smoking history and lung cancer (p = 0.12). All participants responded yes to being open to be educated on reducing their risk of lung cancer (p < 0.05). Conclusions: While many factors still exist with regards to lung cancer screening in minority populations, the cost of medical care, fear of radiation exposure and anxiety were identified as potential barriers to willingness to screen. Structured educational programs were identified as a possible measure that can be implemented to address these factors, with the potential to increase the willingness to undergo screening in a high risk minority population.

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