Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects

: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for a...

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Bibliographic Details
Published in:Cancers 2022-08, Vol.14 (17), p.4089
Main Authors: Gendarme, Sébastien, Pairon, Jean-Claude, Andujar, Pascal, Laurent, François, Brochard, Patrick, Delva, Fleur, Clin, Bénédicte, Gislard, Antoine, Paris, Christophe, Thaon, Isabelle, Goussault, Helene, Canoui-Poitrine, Florence, Chouaïd, Christos
Format: Article
Language:English
Subjects:
Asbestos
Cancer
Cancer screening
Carcinogens
Computed tomography
Cost analysis
Costs
Diagnosis
Economics and Finance
Health aspects
Human health and pathology
Humanities and Social Sciences
Life expectancy
Life Sciences
Lung cancer
Medical prognosis
Medical screening
Mortality
Occupational exposure
Population
Pulmonology and respiratory tract
Questionnaires
Risk factors
Santé publique et épidémiologie
Sensitivity analysis
Smoking
Thorax
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Summary:: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for an asbestos-exposed population. Using Markov modelization, individuals with asbestos exposure were either monitored without intervention or annual low-dose thoracic computed-tomography (LDTCT) scan LC screening. LC incidence came from a prospective observational cohort of subjects with occupational asbestos exposure. The intervention parameters were those of the NLST study. Utilities and LC-management costs came from published reports. A sensitivity analysis evaluated different screening strategies. The respective quality-adjusted life year (QALY) gain, supplementary costs and ICER [95% confidence interval] were: 0.040 [0.010-0.065] QALY, 6900 [3700-11,800] € and 170,000 [75,000-645,000] €/QALY for all asbestos-exposed subjects; and 0.144 [0.071-0.216] QALY, 13,000 [5700-26,800] € and 90,000 [35,000-276,000] €/QALY for smokers with high exposure. When screening was based on biennial LDTCT scans, the ICER was 45,000 [95% CI: 15,000-116,000] €/QALY. Compared to the usual ICER thresholds, biennial LDTCT scan LC screening for smokers with high occupational exposure to asbestos is acceptable and preferable to annual scans.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers14174089