Cost-effectiveness of screening smokers and ex-smokers for lung cancer in the Netherlands in different age groups

Abstract Objective We aimed to assess the cost-effectiveness of screening smokers and ex-smokers for lung cancer in the Netherlands. Methods A Markov model was used to evaluate the health effects and costs of lung cancer screening from the healthcare perspective. The effects and costs of ten screening scenarios with different start and stop ages of screening were examined across a lifetime horizon in a cohort of 100,000 smokers and ex- smokers 50 years and older. Results The incremental cost-effectiveness ratios (ICERs) of screening smokers and ex-smokers aged 50–60 years, 50–70 years, and 50 years and older are below the cost-effectiveness threshold of € 20,000 per quality adjusted life year (QALY) gained. Screening 50–60-year-old smokers and ex-smokers was the most cost-effective scenario with an ICER of € 14,094 per QALY gained. However, screening smokers and ex-smokers 50 years and older yielded the highest QALYs and resulted in an ICER of € 16,594 per QALY, which is below the threshold of € 20,000 per QALY. All screening scenarios compared to no screening resulted in CERs between the € 14,000 and € 16,000 per QALY gained. The efficiency frontier showed that screening smokers and ex-smokers in the age groups 70 years and older, 60–70 years, 60 years and older are excluded by extended dominance by no screening, screening smokers and ex-smokers aged 50–60 years and 50–70 years. Conclusion This study showed that lung cancer screening is cost-effective in the Netherlands.

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Cost-Effectiveness Analysis of Lung Cancer Screening Accounting for the Effect of Indeterminate Findings

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz035 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 2

Author(s):

Iakovos Toumazis ◽

Emily B Tsai ◽

S Ayca Erdogan ◽

Summer S Han ◽

Wenshuai Wan ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Health Benefit ◽

Lung Cancer Screening ◽

Cost Effective ◽

Eligibility Criteria ◽

Screening Strategies ◽

The Cost ◽

The Impact

Abstract Background Numerous health policy organizations recommend lung cancer screening, but no consensus exists on the optimal policy. Moreover, the impact of the Lung CT screening reporting and data system guidelines to manage small pulmonary nodules of unknown significance (a.k.a. indeterminate nodules) on the cost-effectiveness of lung cancer screening is not well established. Methods We assess the cost-effectiveness of 199 screening strategies that vary in terms of age and smoking eligibility criteria, using a microsimulation model. We simulate lung cancer-related events throughout the lifetime of US-representative current and former smokers. We conduct sensitivity analyses to test key model inputs and assumptions. Results The cost-effectiveness efficiency frontier consists of both annual and biennial screening strategies. Current guidelines are not on the frontier. Assuming 4% disutility associated with indeterminate findings, biennial screening for smokers aged 50–70 years with at least 40 pack-years and less than 10 years since smoking cessation is the cost-effective strategy using $100 000 willingness-to-pay threshold yielding the highest health benefit. Among all health utilities, the cost-effectiveness of screening is most sensitive to changes in the disutility of indeterminate findings. As the disutility of indeterminate findings decreases, screening eligibility criteria become less stringent and eventually annual screening for smokers aged 50–70 years with at least 30 pack-years and less than 10 years since smoking cessation is the cost-effective strategy yielding the highest health benefit. Conclusions The disutility associated with indeterminate findings impacts the cost-effectiveness of lung cancer screening. Efforts to quantify and better understand the impact of indeterminate findings on the effectiveness and cost-effectiveness of lung cancer screening are warranted.

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Determining cost-effectiveness of lung cancer screening in urban Chinese populations using a state-transition Markov model

BMJ Open ◽

10.1136/bmjopen-2020-046742 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046742

Author(s):

Chengyao Sun ◽

Xin Zhang ◽

Sirou Guo ◽

Yang Liu ◽

Liangru Zhou ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Urban Areas ◽

Lung Cancer Screening ◽

Cost Effective ◽

Initial Screening ◽

Screening Strategies ◽

Sensitivity Specificity ◽

The Cost

ObjectivesThis study analyses the cost-effectiveness of annual low-dose CT (LDCT) screening of high-risk cancer populations in Chinese urban areas.DesignWe used a Markov model to evaluate LDCT screening from a sociological perspective.SettingThe data from two large lung cancer screening programmes in China were used.ParticipantsThe sample consisted of 100 000 smokers who underwent annual LDCT screening until age 76.InterventionThe study comprises five screening strategies, with the initial screening ages in both the screening strategies and their corresponding non-screening strategies being 40, 45, 50, 55 and 60 years, respectively.Primary and secondary outcome measuresThe incremental cost-effectiveness ratio (ICER) between screening and non-screening strategies at the same initial age was evaluated.ResultsIn the baseline scenario, compared with those who were not screened, the specific mortality from lung cancer decreased by 18.52%–23.13% among those who underwent screening. The ICER of LDCT screening ranges from US$13 056.82 to US$15 736.06 per quality-adjusted life year, which is greater than one but less than three times the gross domestic product per capita in China. An initial screening age of 55 years is the most cost-effective strategy.ConclusionsBaseline analysis shows that annual LDCT screening of heavy smokers in Chinese urban areas is likely to be cost-effective. The sensitivity analysis reveals that sensitivity, specificity and the overdiagnosis rate influence the cost-effectiveness of LDCT screening. All scenarios tested demonstrate cost-effectiveness, except for the combination of worst values of sensitivity, specificity and overdiagnosis. Therefore, the cost-effectiveness of a screening strategy depends on the performance of LDCT screenings.

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A Cost-Effectiveness Analysis of Lung Cancer Screening with Low-Dose Computed Tomography and a Diagnostic Biomarker

JNCI Cancer Spectrum ◽

10.1093/jncics/pkab081 ◽

2021 ◽

Author(s):

Iakovos Toumazis ◽

S Ayca Erdogan ◽

Mehrad Bastani ◽

Ann Leung ◽

Sylvia K Plevritis

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Cost Effective ◽

Diagnostic Biomarker ◽

The Cost ◽

Sensitivity Profile

Abstract Background The Lung Computed Tomography Screening Reporting and Data System (Lung-RADS) reduces the false-positive rate of lung cancer screening but introduces prolonged periods of uncertainty for indeterminate findings. We assess the cost-effectiveness of a screening program that assesses indeterminate findings earlier via a hypothetical diagnostic biomarker introduced in place of Lung-RADS 3 and 4A guidelines. Methods We evaluated the performance of the US Preventive Services Task Force (USPSTF) recommendations on lung cancer screening with and without a hypothetical non-invasive diagnostic biomarker using a validated microsimulation model. The diagnostic biomarker assesses the malignancy of indeterminate nodules, replacing Lung-RADS 3 and 4A guidelines, and is characterized by a varying sensitivity profile that depends on nodule’s size, specificity, and cost. We tested the robustness of our findings through univariate sensitivity analyses. Results A lung cancer screening program per the USPSTF guidelines that incorporates a diagnostic biomarker with at least medium sensitivity profile and 90% specificity, that costs ≤$250, is cost-effective with an incremental cost-effectiveness ratio lower than $100,000 per quality-adjusted life year, and improves lung cancer-specific mortality reduction while requiring fewer screening exams than the USPSTF guidelines with Lung-RADS. A screening program with a biomarker costing ≥$750 is not cost-effective. The health benefits accrued and costs associated with the screening program are sensitive to the disutility of indeterminate findings and specificity of the biomarker, respectively. Conclusions Lung cancer screening that incorporates a diagnostic biomarker, in place of Lung-RADS 3 and 4A guidelines, could improve the cost-effectiveness of the screening program and warrants further investigation.

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

European Journal of Public Health ◽

10.1093/eurpub/ckz186.293 ◽

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.

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Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

10.21203/rs.3.rs-16001/v1 ◽

2020 ◽

Author(s):

Zhi Peng ◽

Xingduo Hou ◽

Yangmu Huang ◽

Tong Xie ◽

Xinyang Hua

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Line Treatment ◽

Lifetime Horizon ◽

Third Line ◽

The Cost ◽

Third Line Treatment

Abstract Background : In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods : A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life year (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set USD 27,130/QALY, which is 3 times gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results : Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting an incremental results effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion : After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

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Cost-Effectiveness of Smoking Cessation Within a Lung Cancer Screening Program in Canada

Journal of Global Oncology ◽

10.1200/jgo.18.26800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 41s-41s ◽

Cited By ~ 1

Author(s):

C. Gauvreau ◽

N. Fitzgerald ◽

W. Flanagan ◽

S. Memon ◽

J. Goffin ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cost Effectiveness ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Participation Rate ◽

Lifetime Horizon ◽

Quit Rate ◽

Low Dose Computed Tomography

Background: Demonstrated lung cancer mortality reductions through low-dose computed tomography (LDCT) has encouraged some jurisdictions to consider implementing organized LDCT screening. A retrospective analysis of former smokers in the National Lung Screening Trial (NLST) suggested that abstention from smoking coupled with low-dose computed tomography (LDCT) screening realized more mortality benefits than abstinence alone or LDCT alone. Aim: We evaluated the potential costs and cost-effectiveness of lung cancer screening with integrated smoking cessation using OncoSim-Lung (version 2.5), a microsimulation model led by the Canadian Partnership Against Cancer, with model development by Statistics Canada. Methods: We compared organized LDCT screening without smoking cessation to various plausible scenarios of screening with cessation. Assumptions included: annual screening of 55-74 year-old individuals with a 30-pack-yr history; a 42% participation rate reached over 10 years; cessation therapy (nicotine replacement therapy + varenicline + 12 weeks' counseling) at a cost of $490; and up to 10 cessation attempts, with a permanent quit rate of 5% per attempt. Cost-effectiveness was estimated with a lifetime horizon, health system perspective and 1.5% discount rate. Costs are in 2016 CAD. Results: OncoSim-Lung projected that LDCT screening integrated with cessation would cost approximately $76 million annually (undiscounted) from 2017 to 2036 in Canada. About 110 fewer lung cancer (LC) cases and 50 fewer LC deaths would occur annually, compared with screening without cessation. Additionally, many other smoking-related deaths would be prevented. Using a lifetime horizon, smoking cessation would cost $14,000/QALYs gained. In one-way sensitivity analysis, with a 72% participation rate there would be 260 fewer deaths, at $24,000/QALY. With a 10% quit rate, cost-effectiveness would improve to $6,000/QALY. A 50% increase in the cost of the cessation intervention would decrease cost-effectiveness to $22,000/QALY. Conclusion: Robust smoking cessation efforts within a LDCT screening program could save lives and be relatively cost-effective. Cancer control planners should consider integrating smoking cessation when implementing a lung cancer screening initiative.

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The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2017.04.021 ◽

2017 ◽

Vol 12 (8) ◽

pp. 1210-1222 ◽

Cited By ~ 45

Author(s):

Sonya Cressman ◽

Stuart J. Peacock ◽

Martin C. Tammemägi ◽

William K. Evans ◽

Natasha B. Leighl ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

High Risk ◽

Lung Cancer Screening ◽

Program Efficiency ◽

The Cost

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Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis

Journal of Fungi ◽

10.3390/jof7060417 ◽

2021 ◽

Vol 7 (6) ◽

pp. 417

Author(s):

Ai Leng Khoo ◽

Ying Jiao Zhao ◽

Glorijoy Shi En Tan ◽

Monica Teng ◽

Jenny Yap ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Antifungal Prophylaxis ◽

Antifungal Treatment ◽

Lifetime Horizon ◽

Old Patients ◽

Risk Patients ◽

The Cost ◽

Quality Adjusted Life

Serial galactomannan (GM) monitoring can aid the diagnosis of invasive aspergillosis (IA) and optimise treatment decisions. However, widespread adoption of mould-active prophylaxis has reduced the incidence of IA and challenged its use. We evaluated the cost-effectiveness of prophylaxis-biomarker strategies. A Markov model simulating high-risk patients undergoing routine GM surveillance with mould-active versus non-mould-active prophylaxis was constructed. The incremental cost for each additional quality-adjusted life-year (QALY) gained over a lifetime horizon was calculated. In 40- and 60-year-old patients receiving mould-active prophylaxis coupled with routine GM surveillance, the total cost accrued was the lowest at SGD 11,227 (USD 8255) and SGD 9234 (USD 6790), respectively, along with higher QALYs gained (5.3272 and 1.1693). This strategy, being less costly and more effective, dominated mould-active prophylaxis with no GM monitoring or GM surveillance during non-mould-active prophylaxis. The prescription of empiric antifungal treatment was influential in the cost-effectiveness. When the GM test sensitivity was reduced from 80% to 30%, as might be anticipated with the use of mould-active prophylactic agents, the conclusion remained unchanged. The likelihood of GM surveillance with concurrent mould-active prophylaxis being cost-effective was 77%. Routine GM surveillance remained cost-effective during mould-active prophylaxis despite lower IA breakthroughs. Cost-saving from reduced empirical antifungal treatment was an important contributing factor.

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Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Orvosi Hetilap ◽

10.1556/650.2017.30731 ◽

2017 ◽

Vol 158 (25) ◽

pp. 963-975

Author(s):

Zoltán Vokó ◽

Magdolna Barra ◽

Anett Molnár ◽

Anna Kerpel-Fronius ◽

Gábor Bajzik ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Low Dose ◽

Health Economic Evaluation ◽

Lung Cancer Screening ◽

Patient Pathways ◽

The Cost ◽

Low Dose Computed Tomography

Abstract: Introduction: Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing low-dose computed tomography screening is a relevant health policy matter. Aim: The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. Method: A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. Results: In accordance with these findings, we recommend to perform the full health-economic evaluation of low-dose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon. Conclusions: The proposed cost-effectiveness model will be suitable to provide data for further analyses that support decision-making on introducing low-dose computed tomography lung cancer screening as public health program. Orv Hetil. 2017; 158(25): 963–975.

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