Your browser doesn't support javascript.
loading
Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study.
Caverly, Tanner J; Cao, Pianpian; Hayward, Rodney A; Meza, Rafael.
Afiliação
  • Caverly TJ; VA Center for Clinical Management Research and University of Michigan Medical School, Ann Arbor, Michigan (T.J.C., R.A.H.).
  • Cao P; University of Michigan, Ann Arbor, Michigan (P.C., R.M.).
  • Hayward RA; VA Center for Clinical Management Research and University of Michigan Medical School, Ann Arbor, Michigan (T.J.C., R.A.H.).
  • Meza R; University of Michigan, Ann Arbor, Michigan (P.C., R.M.).
Ann Intern Med ; 169(1): 1-9, 2018 07 03.
Article em En | MEDLINE | ID: mdl-29809244
Background: Many health systems are exploring how to implement low-dose computed tomography (LDCT) screening programs that are effective and patient-centered. Objective: To examine factors that influence when LDCT screening is preference-sensitive. Design: State-transition microsimulation model. Data Sources: Two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry. Target Population: U.S.-representative sample of simulated patients meeting current U.S. Preventive Services Task Force criteria for screening eligibility. Time Horizon: Lifetime. Perspective: Individual. Intervention: LDCT screening annually for 3 years. Outcome Measures: Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, disutilities (the "degree of dislike") quantifying the burden of screening and follow-up were varied across a likely range. The effect of varying the rate of false-positive screening results and overdiagnosis associated with screening was also examined. Results of Base-Case Analysis: Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides. Results of Sensitivity Analysis: Rates of false-positive findings and overdiagnosed lung cancer were not highly influential. Limitation: The quantitative thresholds that were identified may vary depending on the structure of the microsimulation model. Conclusion: Identifying circumstances in which LDCT screening is more versus less preference-sensitive may help clinicians personalize their screening discussions, tailoring to both preferences and clinical benefit. Primary Funding Source: None.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Detecção Precoce de Câncer / Neoplasias Pulmonares Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Intern Med Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Detecção Precoce de Câncer / Neoplasias Pulmonares Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Intern Med Ano de publicação: 2018 Tipo de documento: Article