Economic Value of Bronchoscopy Technologies that Improves Sensitivity for Malignancy for Peripheral Pulmonary Lesions.

RATIONAL: While previous studies have assessed the clinical or economic value of specific technologies, the economic value of improving sensitivity for malignancy for lung cancer diagnoses broadly across technologies is unclear. OBJECTIVE: To identify the economic value of improving sensitivity of bronchoscopy biopsy for the diagnosis of lung cancer. METHODS: A decision analytic model was developed to quantify the economic value of increased sensitivity for malignancy for bronchoscopy biopsy of peripheral pulmonary lesions. Primary clinical outcomes included time-to-diagnosis and survival. Economic outcomes included (i) net monetary benefit (NMB), defined as the health benefits measured in quality-adjusted life year (QALY) times willingness to pay ($100,000/QALY) net of changes in medical costs, and (ii) incremental cost-effectiveness ratio (ICER). A decision tree modeling framework-with two Markov module branches-was developed. The two Markov modules corresponded to cancer patients who were (i) diagnosed and treated or (ii) undiagnosed and remained untreated. Outcomes were measured from a US payer perspective over 30 years. RESULTS: Improving sensitivity for malignancy by 10 percentage points decreased average time-to-diagnosis for lung cancer patients by 0.85 months (4 weeks) and increased survival by 0.36 years (19 weeks), due to faster treatment initiation. Overall health outcomes improved by 0.20 QALYs per patient. Cost increased by $6,727 per patient primarily through increased treatment costs among those diagnosed with cancer. Increasing sensitivity for malignancy by 10 percentage points improved NMB by $8,729 over 30 years (ICER of $34,052), driven largely by improved sensitivity to early-stage cancer (stage-specific NMB: I/II: $19,805; III: $2,101; IV: -$1,438). Forty-two percent of overall NMB ($3,668) accrued within 5 years of biopsy. The relationship between change in sensitivity and NMB was approximately linear (1% vs. 10% sensitivity improvement corresponded to NMB of $885 vs $8,729). The model was most sensitive to cancer treatment efficacy and follow-up time after a negative result. CONCLUSION: Increasing sensitivity of malignancy by 10 percentage points resulted in a $8,729 improvement in net economic value. Health systems can use this information when making decisions regarding the value of new bronchoscopy technologies. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Quantifying the Value of Reduced Health Disparities: Low-Dose Computed Tomography Lung Cancer Screening of High-Risk Individuals Within the United States.

OBJECTIVE: This study aimed to measure the value of increasing lung cancer screening rates for high-risk individuals and its impact on health disparities. METHODS: The model estimated changes in health economic outcomes if low-dose computed tomography screening increased from current to 100% compliance, following clinical guidelines. Current low-dose computed tomography screening rates were estimated by income, education, and race, using 2017-2019 Behavioral Risk Factor Surveillance System data. The model contained a decision tree module to segment the population by screening outcomes and a Markov chain module to estimate cancer progression over time. Model parameters included information on survival, quality of life, and costs related to cancer diagnosis, treatment, and adverse events. Distributional cost-effectiveness analysis estimated the net monetary value from reduced health disparities-measured using quality-adjusted life expectancy-across income, education, and race groups. Outcomes were assessed over 30 years. RESULTS: Lung cancer screening eligibility using US Preventive Services Task Force guidelines was higher for individuals with income <$15 000 (47.2%) and without a high-school education (46.1%) than individuals with income >$50 000 (16.6%) and with a college degree (13.5%), respectively. Increasing lung cancer screening to 100% compliance was cost-effective ($64 654 per quality-adjusted life-year) and produced economic value by up to $560 per person ($182.1 billion for United States overall). Up to 32.2% of the value was due to reductions in health disparities. CONCLUSIONS: Significant value in increasing lung cancer screening rates derived from reducing health disparities. Policy makers and clinicians may not be appropriately prioritizing cancer screening if value from reducing health disparities is unconsidered.

A Decade of Health Innovation: The Impact of New Medicines on Patient Health and the Implications for NICE's Size of Benefit Multiplier.

OBJECTIVES: This study aimed to estimate the incremental health benefits of pharmaceutical innovations approved between 2011 and 2021 and the share that would surpass the National Institute for Health and Care Excellence (NICE) "size of benefit" decision weight thresholds. METHODS: We identified all US-approved drugs between 2011 and 2021. Health benefits, in terms of quality-adjusted life-years (QALYs) for each treatment, were extracted from published cost-effectiveness analyses. Summary statistics by therapeutic area and cell/gene therapy status identified the treatments with the largest QALY gains. RESULTS: The Food and Drug Administration approved 483 new therapies between 2011 and 2021 and of these 252 had a published cost-effectiveness analysis meeting our inclusion criteria. The average incremental health benefits produced by these treatments were 1.04 QALYs (SD = 2.00) relative to standard of care, with wide variation by therapeutic area. Pulmonary and ophthalmologic therapies produced the highest health benefits with 1.47 (SD = 2.17, n = 13) and 1.41 QALYs gained (SD = 3.53, n = 7), respectively; anesthesiology and urology had the lowest gains (< 0.1 QALYs). Cell and gene therapies produced an average health benefit that was 4 times greater than noncell and gene therapies (4.13 vs 0.96). Among the top treatments in terms of incremental QALYs gained, half (10 of 20) were oncology therapies. Three of 252 treatments (1.2%) met NICE's threshold for a "size of benefit" multiplier. CONCLUSIONS: Treatments for rare disease, oncology, and cell and gene therapies produced some of the highest level of health innovation relative to previous standard of care, but few therapies would have qualified for NICE's "size of benefit" multiplier as currently constructed.