基于模型的低剂量计算机断层扫描联合筛查肺癌、慢性阻塞性肺疾病和心血管疾病的成本-效用分析

IF 3 Q2 ONCOLOGY

JTO Clinical and Research Reports Pub Date : 2025-02-19 DOI:10.1016/j.jtocrr.2025.100813

Carina M. Behr PhD , Maarten J. IJzerman PhD , Michelle M.A. Kip PhD , Harry J.M. Groen MD, PhD , Marjolein A. Heuvelmans MD, PhD , Maarten van den Berge MD, PhD , Pim van der Harst MD, PhD , Marleen Vonder PhD , Rozemarijn Vliegenthart MD, PhD , Hendrik Koffijberg PhD

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引用次数: 0

摘要

低剂量计算机断层扫描筛查肺癌（LC）的条件成本效益已被报道。将LC筛查扩展到慢性阻塞性肺疾病（COPD）和心血管疾病（CVD），以及Big-3，可以以边际成本增加健康效益。本研究旨在评估荷兰Big-3筛查与无筛查和LC筛查相比的成本-效用。方法采用国家肺筛查试验的个体数据和文献汇总数据，建立微观模拟模型，反映护理通路。该模型包括通过筛查和标准护理对三大疾病的检测的模拟。该模型还模拟了肿瘤的生长以及戒烟和治疗的效果。假设（前）吸烟者（55-74岁）根据国家肺筛查试验标准进行模拟。接受（预防性）治疗的筛查检测出疾病的个体经历事件风险降低和生存率提高。采用了荷兰卫生系统观点和生命周期观点。结果LC和CVD同时筛查最具成本效益，与不筛查相比，增加的成本和效果分别为1937欧元和0.22质量调整生命年（QALYs），与LC筛查相比，增加的成本和效果分别为595欧元和0.08欧元。与不进行筛选和LC筛选相比，每个QALY的增量成本效用比分别为8561欧元和7154欧元。LC + CVD筛查以LC + COPD筛查为主，其健康效益较低，成本较高。结论与不筛查或单独筛查LC相比，高危人群同时筛查LC + CVD可获得低成本的健康益处。由于临床证据有限，增加COPD筛查尚不合理。

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Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Introduction

The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands.

Methods

A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted.

Results

Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs.

Conclusions

Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.

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