Cost-effectiveness of volume computed tomography in lung cancer screening: a cohort simulation based on Nelson study outcomes.

Autor:	Pan X; Institute for Diagnostic Accuracy, Groningen, The Netherlands.; Unit of Global Health, University of Groningen, Groningen, The Netherlands., Dvortsin E; Institute for Diagnostic Accuracy, Groningen, The Netherlands., Baldwin DR; Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom.; Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom., Groen HJM; Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Ramaker D; Institute for Diagnostic Accuracy, Groningen, The Netherlands., Ryan J; Health Economics and Payer Evidence, AstraZeneca PLC, Cambridge, United Kingdom., Berge HT; Institute for Diagnostic Accuracy, Groningen, The Netherlands., Velikanova R; Unit of Global Health, University of Groningen, Groningen, The Netherlands.; Health Economics and Outcome Research, Asc Academics B.V, Groningen, The Netherlands., Oudkerk M; Institute for Diagnostic Accuracy, Groningen, The Netherlands.; Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands., Postma MJ; Unit of Global Health, University of Groningen, Groningen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of medical economics [J Med Econ] 2024 Jan-Dec; Vol. 27 (1), pp. 27-38. Date of Electronic Publication: 2023 Dec 13.
DOI:	10.1080/13696998.2023.2288739
Abstrakt:	Objectives: This study aimed to evaluate the cost-effectiveness of lung cancer screening (LCS) with volume-based low-dose computed tomography (CT) versus no screening for an asymptomatic high-risk population in the United Kingdom (UK), utilising the long-term insights provided by the NELSON study, the largest European randomized control trial investigating LCS. Methods: A cost-effectiveness analysis was conducted using a decision tree and a state-transition Markov model to simulate the identification, diagnosis, and treatments for a lung cancer high-risk population, from a UK National Health Service (NHS) perspective. Eligible participants underwent annual volume CT screening and were compared to a cohort without the option of screening. Screen-detected lung cancers, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were predicted. Results: Annual volume CT screening of 1.3 million eligible participants resulted in 96,474 more lung cancer cases detected in early stage, and 73,825 fewer cases in late stage, leading to 53,732 premature lung cancer deaths averted and 421,647 QALYs gained, compared to no screening. The ICER was £5,455 per QALY. These estimates were robust in sensitivity analyses. Limitations: Lack of long-term survival data for lung cancer patients; deficiency in rigorous micro-costing studies to establish detailed treatment costs inputs for lung cancer patients. Conclusions: Annual LCS with volume-based low-dose CT for a high-risk asymptomatic population is cost-effective in the UK, at a threshold of £20,000 per QALY, representing an efficient use of NHS resources with substantially improved outcomes for lung cancer patients, as well as additional societal and economic benefits for society as a whole. These findings advocate evidence-based decisions for the potential implementation of a nationwide LCS in the UK.
Databáze:	MEDLINE
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