Abstract
BackgroundA 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program.Methods and FindingsThe current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses.ConclusionsThe findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.
Highlights
Despite reductions in cigarette consumption and adult smoking prevalence in the years following publication of the 1964 Surgeon General’s Report [1,2] and aggressive tobacco control interventions over the past twenty years [3], lung cancer has remained the leading cause of cancer death among men in the United States since the mid-1950s and among women, since the late 1980s [4]
Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%
The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual low-dose computed tomography (LDCT) screening for lung cancer in a high risk population in clinical recommendations
Summary
Despite reductions in cigarette consumption and adult smoking prevalence in the years following publication of the 1964 Surgeon General’s Report [1,2] and aggressive tobacco control interventions over the past twenty years [3], lung cancer has remained the leading cause of cancer death among men in the United States since the mid-1950s and among women, since the late 1980s [4]. The second study examined the ability of repeated annual low dose CT (LDCT) screening to detect cancer at an earlier stage in a high risk population using a mortality and screening and treatment cost model for the commercially-insured population [7]. This paper demonstrated low payer costs for LDCT screening for lung cancer in per member per month (PMPM) terms: $0.76 PMPM for 2012 dollars compared to $2.50, $1.10, and $0.95 PMPM for Breast, Cervical and Colorectal cancer screening, respectively (2006 dollars) This second study reported that repeated LDCT screenings resulted in a low cost per life-year saved below $19,000 in the base case and below $27,000 (2012 USD) in the highest cost scenario, which is lower than current dollar estimates for cervical or breast cancer screening methods currently recommended by the U.S Preventive Services Task Force [7]. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program
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