Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study.
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.