Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort.
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 $23100 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 $58183 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.
Marshall
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Bayer Diagnostics, Emeryville, CA, USA. marshd@mcmaster.ca
Simpson
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Earle
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Chu
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D000368:Aged; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000175:diagnosis*; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D017059:Models, Econometric; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000191:economics*