Variation in Model-Based Economic Evaluations of Low-Dose Computed Tomography Screening for Lung Cancer: A...

Area of Science:

• Health economics
• Medical imaging
• Public health

Background:

• Economic evaluations of low-dose computed tomography (LDCT) screening for lung cancer exhibit significant heterogeneity.
• Understanding the drivers of this variation is crucial for informed decision-making regarding lung cancer screening programs.

Purpose of the Study:

• To systematically review and analyze the methodological differences in model-based economic evaluations of LDCT lung cancer screening.
• To identify factors contributing to the heterogeneity in cost-effectiveness estimates.

Main Methods:

• An updated systematic review of economic evaluations comparing LDCT screening with no screening or other modalities.
• Inclusion of 35 studies, with detailed data extraction and critical appraisal using the Consensus Health Economic Criteria list.

Main Results:

• Identified variations in geographic and temporal factors, screening intervals, and eligible populations across studies.
• Observed diverse modeling approaches (decision tree, Markov, microsimulation) and outcome measures (cost-effectiveness, cost-utility).
• Noted inconsistent consideration of biases like overdiagnosis, lead-time, and length bias, with newer, complex models generally performing better on appraisal criteria.

Conclusions:

• Significant methodological differences exist across economic evaluations of LDCT lung cancer screening, leading to varied cost-effectiveness estimates.
• Future economic evaluations require careful consideration of identified methodological factors and evidence gaps to improve consistency and agreement.