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Risk-Targeted Lung Cancer Screening: A Cost-Effectiveness Analysis
Vaibhav Kumar1, Joshua T Cohen1, David van Klaveren2
1Tufts Medical Center, Boston, Massachusetts (V.K., J.T.C., J.B.W., P.J.N., D.M.K.).
Annals of Internal Medicine
|January 4, 2018
Summary
Risk-targeted lung cancer screening improves efficiency by preventing more deaths, but gains in life-years and cost-effectiveness are modest. This approach may be cost-effective for all risk groups.
Area of Science:
- Pulmonary Medicine
- Health Economics
- Radiology
Background:
- Low-dose computed tomography (LDCT) is suggested for lung cancer screening in high-risk individuals to enhance efficiency.
- The National Lung Screening Trial (NLST) established eligibility criteria for lung cancer screening.
Purpose of the Study:
- To compare the value of risk-targeted lung cancer screening selection against NLST eligibility criteria.
- To quantify the cost-effectiveness of different lung cancer screening strategies.
Main Methods:
- A cost-effectiveness analysis was performed using a multistate prediction model.
- Data from the National Lung Screening Trial (NLST) were utilized.
- The study population included current and former smokers eligible for lung cancer screening.
Main Results:
- Risk-targeted screening demonstrated greater reductions in lung cancer mortality compared to NLST criteria, especially in higher-risk groups.
- Benefits in life-years and quality-adjusted life-years (QALYs) showed a less pronounced gradient across risk deciles.
- Incremental cost-effectiveness ratios (ICERs) were comparable across risk deciles, with values below $100,000 per QALY.
Conclusions:
- Risk targeting enhances screening efficiency regarding early lung cancer mortality prevention.
- However, the gains in life-years, QALYs, and overall cost-effectiveness are attenuated and modest.
- The findings suggest that risk-targeted screening may be a valuable strategy across various risk deciles.
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