Estimating the cost effectiveness of lung screening in the Australian setting
Principal Investigator
Name
Marianne Weber
Degrees
BA (Hons) PhD
Institution
Cancer Council NSW
Position Title
Research Fellow
Email
About this CDAS Project
Study
NLST
(Learn more about this study)
Project ID
NLST-161
Initial CDAS Request Approval
Sep 15, 2015
Title
Estimating the cost effectiveness of lung screening in the Australian setting
Summary
The NLST is the first randomised controlled trial (RCT) to demonstrate a mortality benefit for lung cancer screening, and the findings represent a significant step forward for lung cancer control in developed nations. It is of interest whether the results of the NLST will translate to the Australian setting where the healthcare structure, resources, and population-base are potentially very different to that in the USA.
In the absence of an Australian-based RCT on lung screening, the Queensland Lung Cancer Screening Study (QLCSS) was conducted to determine low dose computed tomography (LDCT) feasibility for lung screening in Australia. The QLCSS is an observational cohort study that applied the NLST protocol (of the LDCT trial arm) to 256 volunteers recruited to a tertiary hospital in Queensland, Australia.
The objective of this project is to provide a cost-effectiveness estimate for LDCT lung screening in Australia by applying cost data derived from the QLCSS to the health outcomes observed in the NLST. Specifically, we plan to use the numbers of men and women screened in each arm of the NLST (rounds T0-2 and the 5 year follow-up) by 5 year age groups, and the associated proportion of positive screens, complications, incident lung cancers by stage, and deaths (lung cancer and other) for each sub-group. These data will be weighted to the Australian population attending screening and survival will be estimated using Australian life-tables and population-based data on stage-specific lung cancer survival rates and smoking prevalence.
The only published Australian health economic assessment of lung cancer screening to date was conducted in 2005 (1), in which a hypothetical cohort of heavy smokers aged 60-64 had 5 annual CT screens. The outcome of that assessment was not in favour of screening, but changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. It will be of interest whether our trial-based model, in which the number of stage I cancers will be determined by the NLST, will yield a similar result.
(1) Manser, Dalton, Carter, Byrnes, Elwood, Campbell. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer. May 2005;48:171-185
In the absence of an Australian-based RCT on lung screening, the Queensland Lung Cancer Screening Study (QLCSS) was conducted to determine low dose computed tomography (LDCT) feasibility for lung screening in Australia. The QLCSS is an observational cohort study that applied the NLST protocol (of the LDCT trial arm) to 256 volunteers recruited to a tertiary hospital in Queensland, Australia.
The objective of this project is to provide a cost-effectiveness estimate for LDCT lung screening in Australia by applying cost data derived from the QLCSS to the health outcomes observed in the NLST. Specifically, we plan to use the numbers of men and women screened in each arm of the NLST (rounds T0-2 and the 5 year follow-up) by 5 year age groups, and the associated proportion of positive screens, complications, incident lung cancers by stage, and deaths (lung cancer and other) for each sub-group. These data will be weighted to the Australian population attending screening and survival will be estimated using Australian life-tables and population-based data on stage-specific lung cancer survival rates and smoking prevalence.
The only published Australian health economic assessment of lung cancer screening to date was conducted in 2005 (1), in which a hypothetical cohort of heavy smokers aged 60-64 had 5 annual CT screens. The outcome of that assessment was not in favour of screening, but changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. It will be of interest whether our trial-based model, in which the number of stage I cancers will be determined by the NLST, will yield a similar result.
(1) Manser, Dalton, Carter, Byrnes, Elwood, Campbell. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer. May 2005;48:171-185
Aims
To apply NLST health outcomes data to a cost-effectiveness model of lung cancer screening in the Australian setting.
Collaborators
Karen Canfell, Cancer Council NSW
Yoon Jung Kang, Cancer Council NSW
Michael Caruana, Cancer Council NSW
Kwun Fong, University of QLD
Annette McWilliams, Fiona Stanley Hospital
Related Publications
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Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes.
Behar Harpaz S, Weber MF, Wade S, Ngo PJ, Vaneckova P, Sarich PEA, Cressman S, Tammemagi MC, Fong K, Marshall H, McWilliams A, Zalcberg JR, Caruana M, Canfell K
Br J Cancer. 2023 Jan; Volume 128 (Issue 1): Pages 91-101 PUBMED -
Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia.
Wade S, Weber M, Caruana M, Kang YJ, Marshall H, Manser R, Vinod S, Rankin N, Fong K, Canfell K
J Thorac Oncol. 2018 Aug; Volume 13 (Issue 8): Pages 1094-1105 PUBMED