Lung cancer screening by low-dose computed tomography: a cost-effectiveness analysis of alternative programmes in the UK using a newly developed natural history-based economic model
BACKGROUND: A systematic review of economic evaluations for lung cancer identified no economic models of the UK setting based on disease natural history. We first sought to develop a new model of natural history for population screening, then sought to explore the cost-effectiveness of multiple alternative potential programmes. METHODS: An individual patient model (ENaBL) was constructed in MS Excel(R) and calibrated against data from the US National Lung Screening Trial. Costs were taken from the UK Lung Cancer Screening Trial and took the perspective of the NHS and PSS. Simulants were current or former smokers aged between 55 and 80 years and so at a higher risk of lung cancer relative to the general population. Subgroups were defined by further restricting age and risk of lung cancer as predicted by patient self-questionnaire. Programme designs were single, triple, annual and biennial arrangements of LDCT screens, thereby examining number and interval length. Forty-eight distinct screening strategies were compared to the current practice of no screening. The primary outcome was incremental cost-effectiveness of strategies (additional cost per QALY gained). RESULTS: LDCT screening is predicted to bring forward the stage distribution at diagnosis and reduce lung cancer mortality, with decreases versus no screening ranging from 4.2 to 7.7% depending on screen frequency. Overall healthcare costs are predicted to increase; treatment cost savings from earlier detection are outweighed by the costs of over-diagnosis. Single-screen programmes for people 55-75 or 60-75 years with >/= 3% predicted lung cancer risk may be cost-effective at the £30,000 per QALY threshold (respective ICERs of £28,784 and £28,169 per QALY gained). Annual and biennial screening programmes were not predicted to be cost-effective at any cost-effectiveness threshold. LIMITATIONS: LDCT performance was unaffected by lung cancer type, stage or location and the impact of a national screening programme of smoking behaviour was not included. CONCLUSION: Lung cancer screening may not be cost-effective at the threshold of £20,000 per QALY commonly used in the UK but may be cost-effective at the higher threshold of £30,000 per QALY.
Citation
@article{edward2020,
author = {Griffin, Edward and Hyde, Chris and Long, Linda and
Varley-Campbell, Jo and Coelho, Helen and Robinson, Sophie and
Snowsill, Tristan},
title = {Lung Cancer Screening by Low-Dose Computed Tomography: A
Cost-Effectiveness Analysis of Alternative Programmes in the {UK}
Using a Newly Developed Natural History-Based Economic Model},
journal = {Diagn Progn Res},
volume = {4},
number = {1},
pages = {1-11},
date = {2020},
url = {https://tristansnowsill.co.uk/lung-cancer-screening-by-low-dose-computed.html},
doi = {10.1186/s41512-020-00087-y},
langid = {en},
abstract = {BACKGROUND: A systematic review of economic evaluations
for lung cancer identified no economic models of the UK setting
based on disease natural history. We first sought to develop a new
model of natural history for population screening, then sought to
explore the cost-effectiveness of multiple alternative potential
programmes. METHODS: An individual patient model (ENaBL) was
constructed in MS Excel(R) and calibrated against data from the US
National Lung Screening Trial. Costs were taken from the UK Lung
Cancer Screening Trial and took the perspective of the NHS and PSS.
Simulants were current or former smokers aged between 55 and 80
years and so at a higher risk of lung cancer relative to the general
population. Subgroups were defined by further restricting age and
risk of lung cancer as predicted by patient self-questionnaire.
Programme designs were single, triple, annual and biennial
arrangements of LDCT screens, thereby examining number and interval
length. Forty-eight distinct screening strategies were compared to
the current practice of no screening. The primary outcome was
incremental cost-effectiveness of strategies (additional cost per
QALY gained). RESULTS: LDCT screening is predicted to bring forward
the stage distribution at diagnosis and reduce lung cancer
mortality, with decreases versus no screening ranging from 4.2 to
7.7\% depending on screen frequency. Overall healthcare costs are
predicted to increase; treatment cost savings from earlier detection
are outweighed by the costs of over-diagnosis. Single-screen
programmes for people 55-75 or 60-75 years with \textgreater/= 3\%
predicted lung cancer risk may be cost-effective at the £30,000 per
QALY threshold (respective ICERs of £28,784 and £28,169 per QALY
gained). Annual and biennial screening programmes were not predicted
to be cost-effective at any cost-effectiveness threshold.
LIMITATIONS: LDCT performance was unaffected by lung cancer type,
stage or location and the impact of a national screening programme
of smoking behaviour was not included. CONCLUSION: Lung cancer
screening may not be cost-effective at the threshold of £20,000 per
QALY commonly used in the UK but may be cost-effective at the higher
threshold of £30,000 per QALY.}
}