Objectives

Robust economic evaluations are needed to identify efficient strategies for lung cancer prevention that combine brief and intensive smoking cessation intervention programmes with screening using low-dose computed tomography (LDCT) at different ages, frequencies, and coverages. We aimed to assess the cost-effectiveness of smoking cessation approaches combined with lung cancer screening in the European context at a population level from a societal perspective.

Materials and Methods

A microsimulation model that describes the natural history of lung cancer and incorporates several prevention strategies was developed. Discounted lifetime QALYs and costs at a rate of 3% were used to calculate incremental cost-effectiveness ratios, defined as additional costs in 2017 Euros per QALY gained.

Results

Smoking cessation interventions reduce the incidence of lung cancer by 8%-46% and are consistently more effective and cost-effective when starting at younger ages. Screening reduces lung cancer mortality by 1%-24% and is generally less effective and more costly than smoking cessation interventions. The most cost-effective strategy would be to implement intensive smoking cessation interventions at ages 35, 40 and 45, combined with screening every three years between the ages of 55 and 65.

Conclusions

Combining smoking cessation interventions with LDCT screening is a very attractive prevention strategy that substantially diminishes the burden of lung cancer. These combined prevention strategies, especially when providing several intensive interventions for smoking cessation at early ages, are more cost-effective than both approaches separately and allow for a more intensified LDCT without losing efficiency.

中文翻译：

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肺癌初级和二级预防干预对人群健康和经济的影响：基于模型的成本效益分析

目标

需要强有力的经济评估来确定有效的肺癌预防策略，将短期和强化戒烟干预计划与使用不同年龄、频率和覆盖范围的低剂量计算机断层扫描 (LDCT) 进行筛查相结合。我们旨在从社会角度评估欧洲范围内在人群水平上戒烟方法与肺癌筛查相结合的成本效益。

材料和方法

开发了一种描述肺癌自然病程并结合多种预防策略的微观模拟模型。使用折扣终身 QALY 和 3% 的成本来计算增量成本效益比，定义为 2017 年每获得 QALY 的额外成本。

结果

戒烟干预措施可将肺癌的发病率降低 8%-46%，并且在更年轻的年龄开始时始终更有效和更具成本效益。筛查可将肺癌死亡率降低 1%-24%，并且通常不如戒烟干预有效且成本更高。最具成本效益的策略是在 35、40 和 45 岁实施强化戒烟干预措施，并在 55 至 65 岁之间每三年进行一次筛查。

结论

将戒烟干预与 LDCT 筛查相结合是一种非常有吸引力的预防策略，可显着减轻肺癌的负担。这些联合预防策略，尤其是在为早期戒烟提供多种强化干预措施时，比分别采用两种方法更具成本效益，并且可以在不降低效率的情况下进行更强化的 LDCT。