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Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study.
Pubmed ID
31683314 (View this publication on the PubMed website)
Digital Object Identifier
Ann. Intern. Med. 2019 Nov 5

Criss SD, Cao P, Bastani M, Ten Haaf K, Chen Y, Sheehan DF, Blom EF, Toumazis I, Jeon J, de Koning HJ, Plevritis SK, Meza R, Kong CY


BACKGROUND: Recommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST).

OBJECTIVE: To compare the cost-effectiveness of different stopping ages for lung cancer screening.

DESIGN: By using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT).

DATA SOURCES: The NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses' Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator.

TARGET POPULATION: Current, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort.

TIME HORIZON: 45 years.

PERSPECTIVE: Health care sector.

INTERVENTION: Annual LDCT according to NLST, CMS, and USPSTF criteria.

OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).

RESULTS OF BASE-CASE ANALYSIS: The 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates.

RESULTS OF SENSITIVITY ANALYSIS: Probabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%).

LIMITATION: Scenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data.

CONCLUSION: All 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective.

PRIMARY FUNDING SOURCE: CISNET (Cancer Intervention and Surveillance Modeling Network) Lung Group, National Cancer Institute.

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