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Estimating the cost-effectiveness of lung cancer screening with low dose computed tomography for high risk smokers in Australia
Journal of Thoracic Oncology ( IF 20.4 ) Pub Date : 2018-04-22
Stephen Wade, Marianne Weber, Michael Caruana, Yoon-Jung Kang, Henry Marshall, Renee Manser, Shalini Vinod, Nicole Rankin, Kwun Fong, Karen Canfell

Background

Health economic evaluations of lung cancer screening with low dose computerised tomography (LDCT) that are underpinned by clinical outcomes are few.

Methods

We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers aged 55-74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015); lung cancer diagnosis and treatment costs from a 2012 Australian, hospital-based study; lung cancer survival rates from the New South Wales Cancer Registry (2005-2009); and other-cause mortality from Australian life tables, weighted by smoking status. Health utility outcomes, screening participation and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICERs) were calculated for a ten-year time horizon.

Results

LDCT lung screening was estimated at AU$138,000 (80% CI, AU$84,700-$353,000)/life-year gained and AU$233,000 (80% CI, AU$128,000-$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favourable when all-cause mortality and the costs of incidental findings were estimated in sensitivity analyses: AU$157,000/QALY gained This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000-$50,000/QALY.

Conclusions

LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternate screening eligibility criteria, intervals, nodule management, the impact and costs of new therapies, investigations of incidental findings, and incorporating smoking cessation interventions.



中文翻译:

用低剂量计算机体层摄影术对澳大利亚高风险吸烟者进行肺癌筛查的成本效益评估

背景

以临床结果为基础的低剂量计算机断层扫描(LDCT)筛查肺癌的健康经济评估很少。

方法

我们通过将澳大利亚成本和生存数据应用于美国国家肺癌筛查试验(NLST)中观察到的结局,评估了澳大利亚LDCT肺癌筛查的成本效益,该试验在每年三轮的试验中证明了20%的肺癌死亡率在55-74岁的高风险吸烟者中进行筛查。筛查相关费用是根据《医疗保险福利计划》报销率(2015年)估算的;2012年澳大利亚基于医院的研究得出的肺癌诊断和治疗费用;新南威尔士州癌症登记处的肺癌存活率(2005-2009年);以及澳大利亚人寿命表中的其他原因造成的死亡率,并按吸烟状况加权。在NLST中观察到了卫生效用结果,参与筛查和肺癌发生率。

结果

LDCT肺部筛查估计每生命年可增加138,000澳元(80%CI,84,700-353,000澳元),获得233,000澳元(80%CI,128,000-1,110,000澳元)/质量调整生命年(QALY)。如果在敏感性分析中估计全因死亡率和偶然发现的成本,则ICER更为有利:获得了157,000澳元/ QALY,这可以与澳大利亚的指示性支付意愿门槛值30,000-50,000澳元/ QALY进行比较。

结论

在澳大利亚,使用NLST选择和实施标准进行LDCT肺部筛查不太可能具有成本效益。未来的经济评估应考虑替代筛查的资格标准,间隔,结节管理,新疗法的影响和费用,对偶然发现的调查以及纳入戒烟干预措施。

更新日期:2018-04-25
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