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Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada
Sonya Cressman1, Stephen Lam, Martin C Tammemagi
1*The Canadian Centre for Applied Research in Cancer Control, and the British Columbia Cancer Agency, Vancouver, British Columbia, Canada; †The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; ‡Brock University, St. Catherines, Ontario, Canada; §Cancer Care Ontario and the Juravinski Cancer Centre, Hamilton, Ontario, Canada; ‖University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada; ¶The Canadian Centre for Applied Research in Cancer Control, the British Columbia Cancer Agency and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; #The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada; **Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; ††The British Columbia Cancer Agency and The Canadian Centre for Applied Research in Cancer Control and the University of British Columbia, Vancouver, British Columbia, Canada; ‡‡Beatrice Hunter Cancer Research Institute and Dalhousie University, Halifax, Nova Scotia, Canada; §§The Vancouver General Hospital, Vancouver, British Columbia, Canada; ‖‖Fionna Stanley Hospital and Sir Charles Gairdner Hospital, Perth, Western Australia; ¶¶Université Laval, Québec, Canada; ##Vancouver General Hospital, The University of British Columbia, Vancouver, British Columbia, Canada; ***The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; †††Princess Margaret Cancer Centre, Toronto, Ontario, Canada; ‡‡‡University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada; §§§Foothills Medical Centre, Calgary, Alberta, Canada; ‖‖‖Memorial University, St. Johns, Newfoundland, Canada; ¶¶¶The Ottawa Hospital, Ottawa, Ontario, Canada; ###Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ****The Vancouver General Hospital and The University of British Columbia, Vancouver, British
Background:
It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs.
Methods:
Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study.
Results:
The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061).
Conclusion:
In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.
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