Abstract
BackgroundLung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. The aim of this study was to evaluate the cost-effectiveness of lung cancer screening with LDCT in a high-risk population. MethodsThe study used an adapted microsimulation model in a cohort of Dutch heavy smokers for a lifetime horizon from a health insurance perspective. The main outcomes included average cost-effectiveness ratio (ACER), incremental cost-effectiveness ratio (ICER) and lung cancer mortality reduction. The comparator was no screening. Scenarios with different screening intervals and starting and stopping ages were evaluated for 100,000 male heavy smokers and 100,000 female heavy smokers. A cost-effectiveness threshold of 60 k€ per life year gained (LYG) was assumed acceptable. ResultsThe evaluated screening scenarios yielded ACERs ranging from 17.7 to 32.4 k€/LYG for men and from 17.8 to 32.1 k€/LYG for women. The lung cancer mortality reduction ranged from 9.3% to 16.8% for men and from 7.8% to 13.7% for women. The optimal screening scenario was annual screening from 55 to 80 years for men and biennial screening from 50 to 80 years for women, with an ICER of 51.6 and 45.8 k€ per LYG compared with its previous efficient alternative, respectively. Compared with no screening, the optimal screening scenario yielded an ICER of 27.6 k€/LYG for men and 21.1 k€/LYG for women. The mortality reduction of lung cancer was 15.9% for men and 10.6% for women. ConclusionsLung cancer LDCT screening is cost-effective in a high-risk population. The optimal screening scenario is dependent on sex.
Highlights
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the Netherlands [1]
The Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON) confirmed the benefits of low-dose computed tomography (LDCT) screening for lung cancer, showing that lung cancer mortality reduced by 24% for men and 33% for women in the LDCT screening group as compared with the no-screening group at 10 years of follow-up [5]
The primary outcomes of the model assessed for each scenario were average cost-effectiveness ratio (ACER), incremental cost-effectiveness ratio (ICER) and lung cancer mortality reduction
Summary
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the Netherlands [1]. The National Lung Screening Trial (NLST) found that three annual screenings with LDCT in (ex-)smokers aged 55e74 years reduced lung cancer mortality by 20% six years after baseline compared with three annual screenings with chest radiography [4]. Results: The evaluated screening scenarios yielded ACERs ranging from 17.7 to 32.4 kV/LYG for men and from 17.8 to 32.1 kV/LYG for women. The optimal screening scenario was annual screening from 55 to 80 years for men and biennial screening from 50 to 80 years for women, with an ICER of 51.6 and 45.8 kV per LYG compared with its previous efficient alternative, respectively. The optimal screening scenario yielded an ICER of 27.6 kV/LYG for men and 21.1 kV/LYG for women. The mortality reduction of lung cancer was 15.9% for men and 10.6% for women
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