SC18.05 UK Lung Screening Trial Cost Effectiveness and Current Planning Status of International Lung Cancer Screening Programs

Abstract

The pilot UKLS lung cancer RCT screening trial recruited 4,000 individuals [1], using the LLPv2 risk model (5% risk over 5 years) [2]. The lessons learnt from the UKLS CT pilot screening trial are:•UKLS – A Population based trial – all IMD’s (socioeconomic groups) included [1].•Risk Stratification (LLPv2 5 % risk over 5 years) [2].•Volumetric assessment of CT detected nodules [3].•Care Pathway – Management pathway implemented [3].•Early Stage Disease (Stage 1 68%: Stage I&II 86%) [4].•High Proportion suitable for Surgery (83%) [4].•1.7% lung cancers identified at baseline scan [1].•Benign Resection rate – 10.3% (NLST 27%)[1].•Psychological impact – transient not significant [5, 6].•Cost effectiveness modelling within NICE parameters [1]. The cost effectiveness of the UKLS trial has been modelled and compared with that of the US National Lung Screening Trial (NLST), which has published an estimate of $81,000 per quality-adjusted life-year (QALY) as its mean incremental cost-effectiveness ratio (ICER) [7]. All UKLS cost estimates were based on 2011-12 NHS tariffs (Costs provided in $: £1=$1.5 on 30-11-15). Owing to the brief duration of the trial, observations relevant to economic evaluation were limited to cost-incurring events associated with screening and the initial management of screen-detected cancers. Expected outcomes of the cancers detected were simulated on the basis of both life tables and published survival data from other studies. The costs incurred from UKLS are those of baseline and repeat screens ($424,072), diagnostic workup ($113,478), and treatment ($449,243), which totaled $1,036794 (95% CI, $719,332 to $1,350,766). Recruitment costs ($15) per person for invitation and selection) were modelled from the UK colorectal screening program and we assumed a participation rate of 30% of those invited. The gross current costs of the program amounted to $1,133,217 (CI $817,887 to $1,450,610). Summary of findings: The ICER of screen-detection compared with symptomatic detection was estimated at $9495 per life-year gained. Using data from previous studies, we associated quality of life weights with the estimated survival gains, enabling us to report outcomes as QALYs. On this basis, the ICER equaled $12,709 per QALY gained (CI $ 8280 to $18966). The difference in cost effectiveness between NLST and UKLS as suggested by the estimated ICERs is more apparent than real. Most of the discrepancy can be explained by differences between settings in (i) local unit costs, (ii) intensity of resource use, (iii) number of screening rounds and (iv) disease prevalence in the target population. Thus, UKLS selected high-risk subjects only whereas NLST screened a general population, yet the latter reported an ICER as low as $32,000 for its highest-risk quintile. Expected QALY gains from screen-detection were similar in both trials. CT-Screening, cost-effectiveness, CT-implementation