Abstract
ObjectivesEstimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC.MethodsA model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50–75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts.ResultsThe MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD.ConclusionsThe economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective.Key Points• Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50–75 years is potentially cost-effective if screening would cost less than €971 per screened individual.• Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population.• With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective.
Highlights
In The Netherlands, lung cancer (LC) accounts for over 13,000 diagnoses and 10,000 deaths annually [1]
Given its high disease burden, there is interest in early detection through population-based screening using low-dose computed tomography (LDCT) to reduce LC-related mortality. Several studies such as the largest National Lung Screening Trial (NLST) and Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial demonstrated the clinical benefits of LC screening for an at-risk population [2, 3]
Chest LDCT, used in LC screening, can simultaneously detect early stages of chronic obstructive pulmonary disease (COPD) through emphysema or air trapping evaluation and high cardiovascular disease (CVD) risk based on coronary calcium scoring; both diseases pose a large burden on Western societies [9]
Summary
In The Netherlands, lung cancer (LC) accounts for over 13,000 diagnoses and 10,000 deaths annually [1]. Given its high disease burden, there is interest in early detection through population-based screening using low-dose computed tomography (LDCT) to reduce LC-related mortality. Several studies such as the largest National Lung Screening Trial (NLST) and Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial demonstrated the clinical benefits of LC screening for an at-risk population [2, 3]. Chest LDCT, used in LC screening, can simultaneously detect early stages of chronic obstructive pulmonary disease (COPD) through emphysema or air trapping evaluation and high cardiovascular disease (CVD) risk based on coronary calcium scoring; both diseases pose a large burden on Western societies [9]. LC, COPD, and CVD together are called the Big-3 [9]
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