Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

Abstract Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

10.21203/rs.2.11996/v2 ◽

2019 ◽

Author(s):

Boxiang Jiang ◽

Philip A. Linden ◽

Amit Gupta ◽

Craig Jarrett ◽

Stephanie G. Worrell ◽

...

Keyword(s):

Cost Effectiveness ◽

Cancer Screening ◽

Literature Review ◽

Incremental Cost ◽

Pulmonary Nodules ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Lung Field ◽

Cost Effectiveness Ratio

Abstract Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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P3.11-25 Analysis Indicates Low Incremental Cost-Effectiveness Ratio for Implementation of Lung Cancer Screening in Italy

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2018.08.1821 ◽

2018 ◽

Vol 13 (10) ◽

pp. S968 ◽

Cited By ~ 1

Author(s):

G. Veronesi ◽

S. Ghislandi ◽

E. Vanni ◽

E. Dieci ◽

L. Toschi ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Incremental Cost ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio

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Favorable incremental cost-effectiveness ratio for lung cancer screening in Italy

Lung Cancer ◽

10.1016/j.lungcan.2020.03.015 ◽

2020 ◽

Vol 143 ◽

pp. 73-79

Author(s):

Giulia Veronesi ◽

Niccolò Navone ◽

Pierluigi Novellis ◽

Elisa Dieci ◽

Luca Toschi ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Incremental Cost ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio

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PP452 Impact Of Patient Access Schemes On Health Technology Assessment Agency Guidance For Rare Diseases In England and Scotland

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001616 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 38-38

Author(s):

Karen Mark ◽

Prachi Manchanda ◽

Judith Rubinstein ◽

Riza Veronica Inumerable

Keyword(s):

Cost Effectiveness ◽

Health Technology Assessment ◽

Incremental Cost ◽

Rare Diseases ◽

Technology Assessment ◽

Health Technology ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Patient Access ◽

Cost Effectiveness Ratio

IntroductionPatient access schemes (PAS) are agreements that may enable patients to access drugs or other treatments that may not be cost effective under normal circumstances. The aim of this study was to determine whether the use of PAS by the National Institute for Health and Care Excellence (NICE) and Scottish Medicines Consortium (SMC) for recommended drugs can lead to greater access to medications for rare diseases.MethodsReimbursement data for rare diseases between 2004 and 2021 from health technology assessment (HTA) agencies, namely the SMC (Scotland) and NICE (England), were included. The reviews with positive HTA decisions were considered, while those with negative decisions were excluded. Several observations were made from these data and reported.ResultsAmong the total positive reviews (n = 81), 43 included PAS. The inclusion of PAS in manufacturer submissions was more frequent for NICE than for the SMC (79% and 40% percent, respectively). Most of the drugs with PAS were included in the HTA guidance from both agencies. The positive NICE reviews contingent on PAS consisted of 20 drugs. For the same set of drugs, the SMC recommended 14 with PAS and one without PAS; five drugs were not assessed. Adalimumab was recommended by NICE with a PAS (base-case incremental cost-effectiveness ratio of GBP12,336 [EUR14,256]; GBP13,676 [EUR15,804]) and by the SMC without a PAS (base-case incremental cost-effectiveness ratio of GBP22,519 [EUR26,023]). Hence, without a PAS, the drug was costlier per quality-adjusted life-year for the National Health Service (NHS) Scotland.ConclusionsPAS submissions for rare diseases are more frequent for NICE than for the SMC. With the PAS discounts, the overall cost of the drugs is reduced, resulting in cost effectiveness. The SMC approved some drugs for which NICE required a PAS to improve the economic argument. Hence, the use of PAS for these drugs could lead to potential cost-savings to the NHS Scotland.

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Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.4098 ◽

2007 ◽

Vol 25 (33) ◽

pp. 5248-5253 ◽

Cited By ~ 25

Author(s):

Veena Shankaran ◽

June M. McKoy ◽

Neal Dandade ◽

Narissa Nonzee ◽

Cara A. Tigue ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Incremental Cost ◽

Incremental Cost Effectiveness Ratio ◽

Screening Colonoscopy ◽

Cost Effectiveness Ratio ◽

Crc Screening ◽

Low Intensity ◽

The Cost

Purpose Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention. Patients and Methods Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies. Results Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis). Conclusion An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

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Cost-effectiveness analysis with direct-acting antivirals in a cohort of HCV-infected inmates in Italy

ABOUTOPEN ◽

10.33393/ao.2020.2190 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103-111

Author(s):

Roberto Ravasio ◽

Luciano Lucania ◽

Roberto Ranieri ◽

Raquel Dominguez

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Incremental Cost ◽

Medical Costs ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Direct Acting Antivirals ◽

Cost Effectiveness Ratio ◽

Direct Medical Costs ◽

Direct Acting

Objective: To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) versus no drug strategy in HCV-infected inmates, from the perspective of the Italian National Health System (iNHS). Methods: A previous Markov model was adapted to the Italian setting to evaluate the direct medical costs and health outcomes (quality-adjusted life years, QALY) throughout the life of HCV-infected inmates. Epidemiological data, patient characteristics (genotype, METAVIR classification), DAAs sustained virological response (SVR), annual likelihood of transition, treatment costs and utilities were gathered from the literature. The DAAs strategy included the administration of elbasvir/grazoprevir or sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Direct medical costs and QALYs were discounted at a 3.0% annual rate. Cost-effectiveness was evaluated as incremental cost-effectiveness ratio (€, 2019) per QALY gained. A deterministic sensitivity analysis (DSA) was performed. Results: Over a lifetime horizon, the DAAs strategy showed higher health costs per patient compared to no drugs strategy in the base-case analysis (€ 42,571 vs. € 26,119). However, it was associated with an increase of QALYs gained (21.14 vs. 15.67), showing an incremental cost-effectiveness ratio of € 3,010 per QALY. The sensitivity analysis confirmed the base-case results. Conclusions: Extending the DAAs treatment to HCV-infected inmates was estimated to be cost effective from the perspective of the Italian NHS, regardless genotype and METAVIR classification.

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Cost-effectiveness analysis with direct-acting antivirals in a cohort of HCV-infected inmates in Italy

ABOUTOPEN ◽

10.33393/abtpn.2020.2190 ◽

2020 ◽

Vol 7 (1) ◽

pp. 103-111

Author(s):

Roberto Ravasio ◽

Luciano Lucania ◽

Roberto Ranieri ◽

Raquel Dominguez

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Incremental Cost ◽

Medical Costs ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Direct Acting Antivirals ◽

Cost Effectiveness Ratio ◽

Direct Medical Costs ◽

Direct Acting

Objective: To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) versus no drug strategy in HCV-infected inmates, from the perspective of the Italian National Health System (iNHS). Methods: A previous Markov model was adapted to the Italian setting to evaluate the direct medical costs and health outcomes (quality-adjusted life years, QALY) throughout the life of HCV-infected inmates. Epidemiological data, patient characteristics (genotype, METAVIR classification), DAAs sustained virological response (SVR), annual likelihood of transition, treatment costs and utilities were gathered from the literature. The DAAs strategy included the administration of elbasvir/grazoprevir or sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Direct medical costs and QALYs were discounted at a 3.0% annual rate. Cost-effectiveness was evaluated as incremental cost-effectiveness ratio (€, 2019) per QALY gained. A deterministic sensitivity analysis (DSA) was performed. Results: Over a lifetime horizon, the DAAs strategy showed higher health costs per patient compared to no drugs strategy in the base-case analysis (€ 42,571 vs. € 26,119). However, it was associated with an increase of QALYs gained (21.14 vs. 15.67), showing an incremental cost-effectiveness ratio of € 3,010 per QALY. The sensitivity analysis confirmed the base-case results. Conclusions: Extending the DAAs treatment to HCV-infected inmates was estimated to be cost effective from the perspective of the Italian NHS, regardless genotype and METAVIR classification.

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