Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis.
Ann Intern Med
; 176(3): 320-332, 2023 03.
Article
in En
| MEDLINE
| ID: mdl-36745885
ABSTRACT
BACKGROUND:
In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.OBJECTIVE:
To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.DESIGN:
Comparative modeling analysis. DATA SOURCES National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator. TARGET POPULATION 1960 U.S. birth cohort. TIME HORIZON 45 years. PERSPECTIVE U.S. health care sector. INTERVENTION Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model. OUTCOMEMEASURES:
Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost. RESULTS OF BASE-CASEANALYSIS:
Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%). RESULTS OF SENSITIVITY ANALYSES Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.LIMITATION:
Risk models were restricted to age, sex, and smoking-related risk predictors.CONCLUSION:
Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration. PRIMARY FUNDING SOURCE National Cancer Institute (NCI).
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Lung Neoplasms
Type of study:
Diagnostic_studies
/
Etiology_studies
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Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Aspects:
Patient_preference
Limits:
Aged80
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Humans
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Middle aged
Language:
En
Journal:
Ann Intern Med
Year:
2023
Document type:
Article
Country of publication:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
/
USA