The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

被引：122

作者：

Cressman, Sonya ^{[1
,2
]}

Peacock, Stuart J. ^{[1
,2
,3
]}

Tammemagi, Martin C. ^{[4
]}

Evans, William K. ^{[5
,6
]}

Leighl, Natasha B. ^{[7
,8
]}

Goffin, John R. ^{[6
,9
,10
]}

Tremblay, Alain ^{[9
,11
]}

Liu, Geoffrey ^{[7
,8
]}

Manos, Darla ^{[12
,13
]}

MacEachern, Paul ^{[11
,14
]}

Bhatia, Rick ^{[15
]}

Puksa, Serge ^{[6
,9
,10
]}

Nicholas, Garth ^{[16
]}

McWilliams, Annette ^{[17
,18
]}

Mayo, John R. ^{[19
,20
]}

Yee, John ^{[19
,20
]}

English, John C. ^{[19
,20
]}

Pataky, Reka ^{[1
,2
,19
]}

McPherson, Emily ^{[21
]}

Atkar-Khattra, Sukhinder ^{[2
]}

Johnston, Michael R. ^{[22
,23
]}

Schmidt, Heidi ^{[24
]}

Shepherd, Frances A. ^{[7
,8
]}

Soghrati, Kam ^{[25
]}

Amjadi, Kayvan ^{[16
]}

Burrowes, Paul ^{[14
]}

Couture, Christian ^{[26
]}

Sekhon, Harmanjatinder S. ^{[16
]}

Yasufuku, Kazuhiro ^{[8
]}

Goss, Glenwood ^{[16
]}

Ionescu, Diana N. ^{[2
]}

Hwang, David M. ^{[7
]}

Martel, Simon ^{[26
]}

Sin, Don D. ^{[27
]}

Tan, Wan C. ^{[27
]}

Urbanski, Stefan ^{[14
]}

Xu, Zhaolin ^{[12
,13
]}

Tsao, Ming-Sound ^{[7
,8
]}

Lam, Stephen ^{[2
,19
]}

机构：

[1] Canadian Ctr Appl Res Canc Control, Vancouver, BC, Canada

[2] British Columbia Canc Agcy, Vancouver, BC, Canada

[3] Simon Fraser Univ, Vancouver, BC, Canada

[4] Brock Univ, St Catharines, ON, Canada

[5] Canc Care Ontario, Toronto, ON, Canada

[6] McMaster Univ, Hamilton, ON, Canada

[7] Univ Hlth Network, Toronto, ON, Canada

[8] Princess Margaret Canc Ctr, Toronto, ON, Canada

[9] Juravinski Canc Ctr, Hamilton, ON, Canada

[10] McMaster Univ, Hamilton, ON, Canada

[11] Univ Calgary, Arnie Charbonneau Canc Inst, Calgary, AB, Canada

[12] Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada

[13] Dalhousie Univ, Halifax, NS, Canada

[14] Foothills Med Ctr, Calgary, AB, Canada

[15] Mem Univ, St John, NF, Canada

[16] Ottawa Hosp, Res Inst, Ottawa, ON, Canada

[17] Fiona Stanley Hosp, Perth, WA, Australia

[18] Univ Western Australia, Perth, WA, Australia

[19] Univ British Columbia, Vancouver, BC, Canada

[20] Vancouver Gen Hosp, Vancouver, BC, Canada

[21] Math Policy Res, Washington, DC USA

[22] Beatrice Hunter Canc Res Inst, Halifax, NS, Canada

[23] Dalhousie Univ, Halifax, NS, Canada

[24] Univ Hlth Network, Womens Coll Hosp, Sinai Hlth Syst, Joint Dept Med Imaging, Toronto, ON, Canada

[25] Trillium Hlth Partners, Mississauga, ON, Canada

[26] Univ Laval, Quebec City, PQ, Canada

[27] St Pauls Hosp, Inst Heart & Lung Hlth, Ctr Heart Lung Innovat, Vancouver, BC, Canada

来源：

JOURNAL OF THORACIC ONCOLOGY | 2017年 / 12卷 / 08期

关键词：

Cost-effectiveness; Lung cancer screening; Economics; Screening operations; DOSE COMPUTED-TOMOGRAPHY; MORTALITY; CT; ASSOCIATION; PROSTATE; OUTCOMES; SMOKERS; QUALITY; MODELS; TRIAL;

D O I：

10.1016/j.jtho.2017.04.021

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. Methods: Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. Results: Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. Conclusions: Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise. Crown (C) Copyright 2017 Published by Elsevier Inc. on behalf of International Association for the Study of Lung Cancer.

引用

页码：1210 / 1222

页数：13

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