scholarly journals Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations

2020 ◽  
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 ◽  
Initial Screening ◽  
Screening Strategies ◽  
Diagnosis Rate ◽  
Sensitivity Specificity ◽  
The Cost

Abstract Background: Lung cancer is the leading cause of cancer-related death. Currently, lung cancer screening trials have demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer specific and overall mortality. The effectiveness of LDCT has been proven, but its economical efficiency should also be assessed. The purpose of the study is to analyze the cost-effectiveness of annual LDCT screening of high-risk populations in Chinese urban areas.Method: We use Markov model to evaluate LDCT screening from sociological perspective. The sample size is 100,000 smokers who will undergo annual LDCT screening until 76. The study contains 5 screening strategies, the initial screening ages for the five screening strategies and their corresponding unscreened strategies are 40, 45, 50, 55, and 60 years, respectively. Parameters come from the China Lung Cancer Screening Project, cancer registry data, etc. The Incremental Cost-effectiveness Ratio (ICER) between screening and non-screening strategies at the same initial age is evaluated.Result: In base-case scenario, compared with those who are not screened, specific mortality of lung cancer decreased by 18.52%-23.13% of 5 screening strategies. The ICER of LDCT screening is from 13056.82USD to 15736.06USD per quality-adjusted life year (QALY), which is greater than one time and less than three times GDP per capita in China. Initial screening age of 55 is the most cost-effective strategy.Conclusion: Baseline analysis shows that annual LDCT screening in heavy smokers in Chinese urban areas is likely to be cost-effectiveness. Sensitivity analysis shows that sensitivity, specificity and over-diagnosis rate have an impact on cost-effectiveness of LDCT screening, but the results are relatively robust，unless the sensitivity, specificity of LDCT screening and over-diagnosis rate take the worst value at the same time. Therefore, the cost-effectiveness of screening strategy depends on the performance of LDCT screening.

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

BMJ Open ◽  
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.

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

2019 ◽  
Vol 3 (3) ◽  
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.

Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review

2016 ◽  
Vol 14 (4) ◽  
pp. 409-418 ◽  
Author(s):  
Adam J. N. Raymakers ◽  
John Mayo ◽  
Stephen Lam ◽  
J. Mark FitzGerald ◽  
David G. T. Whitehurst ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Screening Strategies ◽  
Low Dose Computed Tomography

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

2017 ◽  
Vol 12 (8) ◽  
pp. 1210-1222 ◽  
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

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

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.

scholarly journals Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

2018 ◽  
Vol 13 (8) ◽  
pp. 1094-1105 ◽  
Author(s):  
Stephen Wade ◽  
Marianne Weber ◽  
Michael Caruana ◽  
Yoon-Jung Kang ◽  
Henry Marshall ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
The Cost ◽  
Low Dose Computed Tomography

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

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.

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

2022 ◽  
Author(s):  
Mohamed N. M. T. Al Khayat ◽  
Job F. H. Eijsink ◽  
Maarten J. Postma ◽  
Ewoudt M. W. van de Garde ◽  
Marinus van Hulst
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
The Netherlands ◽  
Age Groups ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Lifetime Horizon ◽  
The Cost

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.

scholarly journals Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

2021 ◽  
Author(s):  
Christopher J Cadham ◽  
Pianpian Cao ◽  
Jinani Jayasekera ◽  
Kathryn L Taylor ◽  
David T Levy ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Cancer Registries ◽  
Web Based ◽  
Screening Programs ◽  
Life Years

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.

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