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Cost-Effectiveness of Management Algorithms for Lung-RADS Category 4 Nodules
Mark M Hammer1, Sumit Gupta1, Chung Yin Kong1
1Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H., S.G.); and Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.).
Radiology. Cardiothoracic Imaging
|May 10, 2021
Summary
The British Thoracic Society (BTS) algorithm and Lung Reporting and Data System (Lung-RADS) are cost-effective for managing category 4 lung nodules. BTS provided greater quality-adjusted life years (QALYs) in simulations.
Area of Science:
- Pulmonary Medicine
- Health Economics
- Radiology
Background:
- Lung nodule management guidelines are crucial for early lung cancer detection.
- Lung Reporting and Data System (Lung-RADS) category 4 nodules require careful management due to their indeterminate malignancy risk.
- Evaluating the cost-effectiveness of different management algorithms is essential for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To compare the cost-effectiveness of various nodule management guidelines for Lung-RADS category 4 nodules.
- To evaluate the impact of different algorithms on patient health outcomes, including quality-adjusted life years (QALYs) and cancer diagnosis delays.
- To determine the most economically efficient strategy for managing indeterminate lung nodules.
Main Methods:
- A retrospective simulation of 100,000 patients with Lung-RADS 4 nodules, based on data from 151 real patients.
- Management algorithms, including British Thoracic Society (BTS), American College of Chest Physicians, and Lung-RADS, were applied to simulated patients.
- Health outcomes (QALYs, mortality) and costs (interventions, cancer treatment) were accumulated; sensitivity analyses were performed.
Main Results:
- The BTS algorithm yielded the highest QALYs (10.041), followed by American College of Chest Physicians (10.035) and Lung-RADS (10.021).
- BTS and Lung-RADS were on the efficient frontier, with an incremental cost-effectiveness ratio (ICER) of $52,634.
- Sensitivity analyses consistently identified BTS and Lung-RADS as the most cost-effective algorithms.
Conclusions:
- Both the BTS algorithm and Lung-RADS are cost-effective strategies for managing Lung-RADS category 4 nodules.
- The BTS algorithm demonstrated superior cost-effectiveness, providing greater QALYs compared to Lung-RADS.
- These findings support the use of BTS and Lung-RADS guidelines in clinical practice for optimizing lung nodule management.
