Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand

被引:19
作者
Jaine, Richard [1 ,2 ]
Kvizhinadze, Giorgi [1 ]
Nair, Nisha [1 ]
Blakely, Tony [1 ]
机构
[1] Univ Otago, Dept Publ Hlth, Burden Dis Epidemiol Equ & Cost Effectiveness Pro, Wellington, New Zealand
[2] Univ Otago, POB 7343, Wellington 6242, New Zealand
关键词
Lung cancer; Screening; Cost-effectiveness; New Zealand; INCIDENTAL FINDINGS; PROGNOSTIC-FACTOR; CIGARETTE-SMOKING; NEVER-SMOKERS; MORTALITY; HISTOLOGY; PATTERNS; SURVIVAL; OUTCOMES; DISEASE;
D O I
10.1016/j.lungcan.2020.03.010
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objectives: The cost-effectiveness of low-dose computed tomography (LDCT) screening for lung cancer is uncertain. This study estimated the health gains, costs (net health system, and including 'unrelated') and cost-effectiveness of biennial LDCT screening among 55-74 years olds with a smoking history of at least 30 pack years, and (if a former smoker) having quit within last 15 years, in New Zealand. Methods: We used a macrosimulation stage shift model with New Zealand-specific lung cancer incidence rates and intervention parameters from the National Lung Screening Trial, a health system perspective, and a lifetime horizon for quality-adjusted life-years (QALYs) and costs discounted at 3% per annum. We also examined heterogeneity by gender, ethnicity (Maori (indigenous population) versus non-Maori), age and smoking status. Results and Conclusion: We estimated 0.067 QALYs gained (95 % uncertainty interval (UI) 0.044 to 0.095) per eligible participant, at a cost of US$2843 ($2067-3797; 2011 $US). The overall incremental cost effectiveness ratio (ICER) was US$44,000 per QALY gained (95 % UI US$27,000 to US$70,000). The ICER was substantially lower for Maori, at US$26,000 per QALY gained (95 % UI US$17,000 to US$39,000). The cost-effectiveness varied by socio-demographics, from US$21,000 for 70-74 year old Maori females to US$60,000 for 55-59 year old non-Maori males. The two scenarios that lowered the ICER the most were halving the screening costs (ICER = US$33,000 per QALY), and improving the sensitivity (from 93.8% to 98%) and specificity (from 73.4% to 95%) of the screening test (ICER = US$23,000 per QALY). Based on a threshold of GDP per capita per QALY gained (i.e. US$30,000), LDCT screening for lung cancer is unlikely to be cost-effective in New Zealand for the proposed target population under our modelling assumptions. However, it is likely to be cost-effective for Maori, a population group which carries a disproportionately high disease burden from lung cancer.
引用
收藏
页码:99 / 106
页数:8
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