Stephen Wade1, Marianne Weber2, Michael Caruana1, Yoon-Jung Kang1, Henry Marshall3, Renee Manser4, Shalini Vinod5, Nicole Rankin1, Kwun Fong3, Karen Canfell6. 1. Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia. 2. Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia. Electronic address: mariannew@nswcc.org.au. 3. Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia; University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Queensland, Australia. 4. Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia. 5. South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia. 6. Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia; School of Public Health, University of Sydney, New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, New South Wales, Australia.
Abstract
INTRODUCTION: Health economic evaluations of lung cancer screening with low-dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few. METHODS: We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers age 55 to 74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015), lung cancer diagnosis and treatment costs from a 2012 Australian hospital-based study, lung cancer survival rates from the New South Wales Cancer Registry (2005-2009), and other-cause mortality from Australian life tables weighted by smoking status. The health utility outcomes, screening participation rates, and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICER) were calculated for a 10-year time horizon. RESULTS: The cost-effectiveness of LDCT lung screening was estimated at AU$138,000 (80% confidence interval: AU$84,700-AU$353,000)/life-year gained and AU$233,000 (80% confidence interval: AU$128,000-AU$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favorable when LDCT screening impact on all-cause mortality was considered, even when the costs of incidental findings were also estimated in sensitivity analyses: AU$157,000/QALY gained. This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000 to AU$50,000/QALY. CONCLUSIONS: LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternative screening eligibility criteria, intervals, nodule management, the impact and cost of new therapies, investigations of incidental findings, and incorporation of smoking cessation interventions.
INTRODUCTION: Health economic evaluations of lung cancer screening with low-dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few. METHODS: We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers age 55 to 74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015), lung cancer diagnosis and treatment costs from a 2012 Australian hospital-based study, lung cancer survival rates from the New South Wales Cancer Registry (2005-2009), and other-cause mortality from Australian life tables weighted by smoking status. The health utility outcomes, screening participation rates, and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICER) were calculated for a 10-year time horizon. RESULTS: The cost-effectiveness of LDCT lung screening was estimated at AU$138,000 (80% confidence interval: AU$84,700-AU$353,000)/life-year gained and AU$233,000 (80% confidence interval: AU$128,000-AU$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favorable when LDCT screening impact on all-cause mortality was considered, even when the costs of incidental findings were also estimated in sensitivity analyses: AU$157,000/QALY gained. This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000 to AU$50,000/QALY. CONCLUSIONS: LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternative screening eligibility criteria, intervals, nodule management, the impact and cost of new therapies, investigations of incidental findings, and incorporation of smoking cessation interventions.
Authors: Jon D Emery; Sonya R Murray; Fiona M Walter; Andrew Martin; Stephen Goodall; Danielle Mazza; Emily Habgood; Yvonne Kutzer; David John Barnes; Peter Murchie Journal: Thorax Date: 2019-01-10 Impact factor: 9.139