Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2001-06, Vol.32 (3), p.227-236
• Main Authors: Marshall, Deborah, Simpson, Kit N, Earle, Craig C, Chu, Chee-Wui
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cohort Studies; Computer Simulation; Cost-Benefit Analysis; Cost-effectiveness analysis; Decision Trees; Early Lung Cancer Action Project; Helical computed-tomography; Humans; Investigative techniques, diagnostic techniques (general aspects); Life Expectancy; Lung cancer screening; Lung Neoplasms - diagnosis; Mass Screening - economics; Medical sciences; Middle Aged; Models, Econometric; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Risk Factors; Survival Analysis; Tomography, X-Ray Computed - economics
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/S0169-5002(00)00239-7

The development of low-dose helical computed-tomography (CT) scanning to detect nodules as small as a few mm has sparked renewed interest in lung cancer (LC) screening. The objective of this study was to assess the potential health effects and cost-effectiveness of a one-time low-dose helical CT scan to screen for LC. We created a decision analysis model using baseline results from the Early Lung Cancer Action Project (ELCAP); Surveillance, Epidemiology and End Results (SEER) registry public-use database; screening program costs estimated from 1999 Medicare reimbursement rates; and annual costs of managing cancer and non-cancer patients from Riley et al. (1995) [Med Care 1995;33(8):828–841] and Taplin et al. (1995) [J Natl Cancer Inst 1995;87(6):417–26]. The main outcome measures included years of life, cost estimates of baseline diagnostic screening and follow up, and cost-effectiveness of screening. We found that in a very high-risk cohort (LC prevalence of 2.7%) of patients between 60 and 74 years of age, a one-time screen appears to be cost-effective at $5940 per life year saved. In a lower risk general population of smokers (LC prevalence of 0.7%), a one-time screen appears to be cost-effective at $23 100 per life year. Even when a lead-time bias of 1 year is incorporated into the model for a low risk population, the cost-effectiveness is estimated at $58 183 per life year. Based on the assumptions embedded in this model, one-time screening of elderly high-risk patients for LC appears to be cost-effective.