Downstream Complications and Healthcare Expenditure after Invasive Procedures for Lung Lesions in Taiwan

This study aimed to estimate the downstream complications and healthcare expenditure after invasive procedures for lung lesions, which in turn could be used for future cost-effectiveness analyses of lung cancer screening in Taiwan. We interlinked the Taiwan National Beneficiary Registry with the National Health Insurance Reimbursement databases to identify non-lung cancer individuals aged 50–80 years who underwent invasive lung procedures within one month after non-contrast chest computed tomography between 2014 and 2016. We directly matched one individual with 10 controls by age, gender, calendar year, residence area, comorbidities, and the past one-year healthcare expenditure to calculate incremental one-month complication rates and attributable costs. A total of 5805 individuals who underwent invasive lung procedures were identified and matched with 58,050 controls. The incremental one-month complication rates were 13.4% (95% CI: 10.9% to 15.8%), 10.7% (95% CI: 9.2% to 12.1%), and 4.4% (95% CI: 2.0% to 6.7%) for thoracic surgery, bronchoscopy, and needle biopsy, respectively. The incremental one-month healthcare expenditure for minor, intermediate, and major complications were NT$1493 (95% CI: NT$-3107 to NT$6092), NT$18,422 (95% CI: NT$13,755 to NT$23,089), and NT$58,021 (95% CI: NT$46,114 to NT$69,929), respectively. Individuals aged 60–64 years incurred the highest incremental costs. Downstream complications and the healthcare expenditure after invasive procedures for lung lesions would be substantial for non-lung cancer individuals 50–80 years of age. These estimates could be used in modeling the cost-effectiveness of the national lung screening program in Taiwan.

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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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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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Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration

Journal of General Internal Medicine ◽

10.1007/s11606-021-07011-0 ◽

2021 ◽

Author(s):

Jaimee L. Heffner ◽

Scott Coggeshall ◽

Chelle L. Wheat ◽

Paul Krebs ◽

Laura C. Feemster ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Tobacco Treatment ◽

One Year

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The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program

Radiographics ◽

10.1148/rg.2015150079 ◽

2015 ◽

Vol 35 (7) ◽

pp. 1893-1908 ◽

Cited By ~ 47

Author(s):

Florian J. Fintelmann ◽

Adam Bernheim ◽

Subba R. Digumarthy ◽

Inga T. Lennes ◽

Mannudeep K. Kalra ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Cancer Screening Program ◽

Lung Cancer Screening Program

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PS01.02 National Lung Cancer Screening Program in Taiwan: The TALENT Study

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.318 ◽

2021 ◽

Vol 16 (3) ◽

pp. S58

Author(s):

P. Yang

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Cancer Screening Program ◽

Lung Cancer Screening Program

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

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab002 ◽

2021 ◽

Cited By ~ 1

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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Understanding Cost-Effectiveness Analyses: An Explanation Using Three Different Analyses of Lung Cancer Screening

American Journal of Roentgenology ◽

10.2214/ajr.14.14038 ◽

2015 ◽

Vol 205 (2) ◽

pp. 344-347 ◽

Cited By ~ 1

Author(s):

Patti K. Curl ◽

James G. Kahn ◽

Karen G. Ordovas ◽

Brett M. Elicker ◽

David M. Naeger

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Lung Cancer Screening

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Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers

Public Health Reports ◽

10.1177/0033354920971717 ◽

2021 ◽

pp. 003335492097171

Author(s):

Lesley Watson ◽

Megan M. Cotter ◽

Shauna Shafer ◽

Kara Neloms ◽

Robert A. Smith ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Screening Program ◽

Lung Cancer Screening ◽

Pilot Project ◽

Health Centers ◽

Smoking History ◽

Federally Qualified Health Centers ◽

Cancer Society ◽

Improved Outcomes

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology–designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January–June 2016) followed by 2 years of implementation (July 2016–June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

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