Szu-Chun Yang1, Wu-Wei Lai2, Chien-Chung Lin3, Wu-Chou Su4, Li-Jung Ku5, Jing-Shiang Hwang6, Jung-Der Wang7. 1. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan. Electronic address: szuchunyang@yahoo.com.tw. 2. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan. Electronic address: lai.wuwei@gmail.com. 3. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan. Electronic address: chausus@ms31.hinet.net. 4. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan. Electronic address: sunnysu@mail.ncku.edu.tw. 5. Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan. Electronic address: eljku@mail.ncku.edu.tw. 6. Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Section 2, Taipei 115, Taiwan. Electronic address: jshwang@stat.sinica.edu.tw. 7. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan. Electronic address: jdwang121@gmail.com.
Abstract
BACKGROUND: A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. METHODS: The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. RESULTS: The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. CONCLUSIONS: Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.
BACKGROUND: A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. METHODS: The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. RESULTS: The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. CONCLUSIONS: Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.
Authors: Eduardo Edelman Saul; Raquel B Guerra; Michelle Edelman Saul; Laercio Lopes da Silva; Gabriel F P Aleixo; Raquel M K Matuda; Gilberto Lopes Journal: Nat Cancer Date: 2020-11-30