The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

Sonya Cressman, Stuart J. Peacock, Martin C. Tammemägi, William K. Evans, Natasha B. Leighl, John R. Goffin, Alain Tremblay, Geoffrey Liu, Daria Manos, Paul MacEachern, Rick Bhatia, Serge Puksa, Garth Nicholas, Annette McWilliams, John R. Mayo, John Yee, John C. English, Reka Pataky, Emily McPherson, Sukhinder Atkar-KhattraMichael R. Johnston, Heidi Schmidt, Frances A. Shepherd, Kam Soghrati, Kayvan Amjadi, Paul Burrowes, Christian Couture, Harmanjatinder S. Sekhon, Kazuhiro Yasufuku, Glenwood Goss, Diana N. Ionescu, David M. Hwang, Simon Martel, Don D. Sin, Wan C. Tan, Stefan Urbanski, Zhaolin Xu, Ming Sound Tsao, Stephen Lam

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Introduction: Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. Methods: Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. Results: Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life-year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. Conclusions: Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise.

Original languageEnglish
Pages (from-to)1210-1222
JournalJournal of Thoracic Oncology
Volume12
Issue number8
DOIs
Publication statusPublished - Aug 2017

Fingerprint Dive into the research topics of 'The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency'. Together they form a unique fingerprint.

Cite this