Risk-targeted lung cancer screening: A cost-effectiveness analysis
Menée à partir d'un modèle mathématique, cette étude analyse le rapport coût-efficacité d'un programme de dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnements chez les fumeurs et anciens fumeurs présentant un risque élevé de décès par cancer du poumon
Background : Targeting low-dose computed tomography (LDCT) for lung cancer screening to persons at highest risk for lung cancer mortality has been suggested to improve screening efficiency.
Objective : To quantify the value of risk-targeted selection for lung cancer screening compared with National Lung Screening Trial (NLST) eligibility criteria.
Design : Cost-effectiveness analysis using a multistate prediction model.
Data Sources: NLST.
Target Population: Current and former smokers eligible for lung cancer screening.
Time Horizon: Lifetime.
Perspective: Health care sector.
Intervention: Risk-targeted versus NLST-based screening.
Outcome Measures: Incremental 7-year mortality, life expectancy, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of screening with LDCT versus chest radiography at each decile of lung cancer mortality risk.
Results of Base-Case Analysis: Participants at greater risk for lung cancer mortality were older and had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits during the first 7 years ranged from 1.2 to 9.5 lung cancer deaths prevented per 10 000 person-years for the lowest to highest risk deciles, respectively (extreme decile ratio, 7.9). The gradient of benefits across risk groups, however, was attenuated in terms of life-years (extreme decile ratio, 3.6) and QALYs (extreme decile ratio, 2.4). The incremental cost-effectiveness ratios (ICERs) were similar across risk deciles ($75 000 per QALY in the lowest risk decile to $53 000 per QALY in the highest risk decile). Payers willing to pay $100 000 per QALY would pay for LDCT screening for all decile groups.
Results of Sensitivity Analysis: Alternative assumptions did not substantially alter our findings.
Limitation: Our model did not account for all correlated differences between lung cancer mortality risk and quality of life.
Conclusions: Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are attenuated and modest in terms of life-years, QALYs, and cost-effectiveness.
Primary Funding Source: National Institutes of Health (U01NS086294).
Annals of Internal Medicine , résumé, 2017