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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.
Pubmed ID
36323879 (View this publication on the PubMed website)
Digital Object Identifier
Br J Cancer. 2023 Jan; Volume 128 (Issue 1): Pages 91-101
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
  • The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia.
  • The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia.
  • Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
  • Department of Health Sciences, Brock University, St Catharines, ON, Canada.
  • Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia.
  • Fiona Stanley Hospital, Murdoch, WA, Australia.
  • School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

BACKGROUND: A national, lung cancer screening programme is under consideration in Australia, and we assessed cost-effectiveness using updated data and assumptions.

METHODS: We estimated the cost-effectiveness of lung screening by applying screening parameters and outcomes from either the National Lung Screening Trial (NLST) or the NEderlands-Leuvens Longkanker Screenings ONderzoek (NELSON) to Australian data on lung cancer risk, mortality, health-system costs, and smoking trends using a deterministic, multi-cohort model. Incremental cost-effectiveness ratios (ICERs) were calculated for a lifetime horizon.

RESULTS: The ICER for lung screening compared to usual care in the NELSON-based scenario was AU$39,250 (95% CI $18,150-108,300) per quality-adjusted life year (QALY); lower than the NLST-based estimate (ICER = $76,300, 95% CI $41,750-236,500). In probabilistic sensitivity analyses, lung screening was cost-effective in 15%/60% of NELSON-like simulations, assuming a willingness-to-pay threshold of $30,000/$50,000 per QALY, respectively, compared to 0.5%/6.7% for the NLST. ICERs were most sensitive to assumptions regarding the screening-related lung cancer mortality benefit and duration of benefit over time. The cost of screening had a larger impact on ICERs than the cost of treatment, even after quadrupling the 2006-2016 healthcare costs of stage IV lung cancer.

DISCUSSION: Lung screening could be cost-effective in Australia, contingent on translating trial-like lung cancer mortality benefits to the clinic.

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