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Published on: August 28, 2018
Cost-effectiveness of one-off upper abdominal CT screening as an add-on to lung cancer screening in England
Chloe Thomas1, Laura Heathcote2, Yuxiao Sun2,3
1Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK. c.thomas@sheffield.ac.uk.
Background:
Low-dose computed tomography (CT) screening for lung cancer is available for high-risk individuals in England. Screening simultaneously for upper abdominal conditions, including cancer, is feasible. Here, we estimate the cost-effectiveness of one-off upper abdominal CT screening, added onto lung cancer screening, based on the Yorkshire Kidney Screening Trial (YKST) feasibility study.
Methods:
A multi-disease health economic model was developed. Ten cancers and abdominal aortic aneurysm (AAA) were modelled over a lifetime horizon. YKST data informed disease prevalence, resource use and screening costs. Costs, quality-adjusted life-years (QALYs) and cost-effectiveness were estimated probabilistically.
Results:
Screening per person costs £70.89, produces 0.0059 QALYs, and has 96% probability of being cost-effective, with an incremental cost-effectiveness ratio of £12,085. AAA contributes most to cost-effectiveness, followed by kidney cancer, but some cancer findings reduce cost-effectiveness. Screening is more cost-effective at younger ages. Screen-detectable disease prevalence, severity and mortality risk contribute most to uncertainty.
Conclusions:
One-off upper abdominal CT screening is potentially cost-effective, but costs, harms and benefits vary between conditions. Cost-effectiveness is driven by early diagnosis of AAA, then kidney cancer, illustrating the importance of considering all relevant diseases in screening models. A larger trial would provide more robust data to refine the cost-effectiveness argument.
Clinical Trial Registration:
ClinicalTrials.gov: NCT05005195.
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