Vaibhav Kumar, Joshua T Cohen, David van Klaveren, Djøra I Soeteman, John B Wong, Peter J Neumann, David M Kent
{"title":"Risk-Targeted Lung Cancer Screening: A Cost-Effectiveness Analysis.","authors":"Vaibhav Kumar, Joshua T Cohen, David van Klaveren, Djøra I Soeteman, John B Wong, Peter J Neumann, David M Kent","doi":"10.7326/M17-1401","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Targeting low-dose computed tomography (LDCT) for lung cancer screening to persons at highest risk for lung cancer mortality has been suggested to improve screening efficiency.</p><p><strong>Objective: </strong>To quantify the value of risk-targeted selection for lung cancer screening compared with National Lung Screening Trial (NLST) eligibility criteria.</p><p><strong>Design: </strong>Cost-effectiveness analysis using a multistate prediction model.</p><p><strong>Data sources: </strong>NLST.</p><p><strong>Target population: </strong>Current and former smokers eligible for lung cancer screening.</p><p><strong>Time horizon: </strong>Lifetime.</p><p><strong>Perspective: </strong>Health care sector.</p><p><strong>Intervention: </strong>Risk-targeted versus NLST-based screening.</p><p><strong>Outcome measures: </strong>Incremental 7-year mortality, life expectancy, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of screening with LDCT versus chest radiography at each decile of lung cancer mortality risk.</p><p><strong>Results of base-case analysis: </strong>Participants at greater risk for lung cancer mortality were older and had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits during the first 7 years ranged from 1.2 to 9.5 lung cancer deaths prevented per 10 000 person-years for the lowest to highest risk deciles, respectively (extreme decile ratio, 7.9). The gradient of benefits across risk groups, however, was attenuated in terms of life-years (extreme decile ratio, 3.6) and QALYs (extreme decile ratio, 2.4). The incremental cost-effectiveness ratios (ICERs) were similar across risk deciles ($75 000 per QALY in the lowest risk decile to $53 000 per QALY in the highest risk decile). Payers willing to pay $100 000 per QALY would pay for LDCT screening for all decile groups.</p><p><strong>Results of sensitivity analysis: </strong>Alternative assumptions did not substantially alter our findings.</p><p><strong>Limitation: </strong>Our model did not account for all correlated differences between lung cancer mortality risk and quality of life.</p><p><strong>Conclusions: </strong>Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are attenuated and modest in terms of life-years, QALYs, and cost-effectiveness.</p><p><strong>Primary funding source: </strong>National Institutes of Health (U01NS086294).</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"161-169"},"PeriodicalIF":17.2000,"publicationDate":"2018-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7326/M17-1401","citationCount":"54","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/M17-1401","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/1/2 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 54
Abstract
Background: Targeting low-dose computed tomography (LDCT) for lung cancer screening to persons at highest risk for lung cancer mortality has been suggested to improve screening efficiency.
Objective: To quantify the value of risk-targeted selection for lung cancer screening compared with National Lung Screening Trial (NLST) eligibility criteria.
Design: Cost-effectiveness analysis using a multistate prediction model.
Data sources: NLST.
Target population: Current and former smokers eligible for lung cancer screening.
Time horizon: Lifetime.
Perspective: Health care sector.
Intervention: Risk-targeted versus NLST-based screening.
Outcome measures: Incremental 7-year mortality, life expectancy, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of screening with LDCT versus chest radiography at each decile of lung cancer mortality risk.
Results of base-case analysis: Participants at greater risk for lung cancer mortality were older and had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits during the first 7 years ranged from 1.2 to 9.5 lung cancer deaths prevented per 10 000 person-years for the lowest to highest risk deciles, respectively (extreme decile ratio, 7.9). The gradient of benefits across risk groups, however, was attenuated in terms of life-years (extreme decile ratio, 3.6) and QALYs (extreme decile ratio, 2.4). The incremental cost-effectiveness ratios (ICERs) were similar across risk deciles ($75 000 per QALY in the lowest risk decile to $53 000 per QALY in the highest risk decile). Payers willing to pay $100 000 per QALY would pay for LDCT screening for all decile groups.
Results of sensitivity analysis: Alternative assumptions did not substantially alter our findings.
Limitation: Our model did not account for all correlated differences between lung cancer mortality risk and quality of life.
Conclusions: Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are attenuated and modest in terms of life-years, QALYs, and cost-effectiveness.
Primary funding source: National Institutes of Health (U01NS086294).
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
