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A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions

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  • Andrea C Villanti
  • Yiding Jiang
  • David B Abrams
  • Bruce S Pyenson

Abstract

Background: A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50–64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program. Methods and Findings: The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses. Conclusions: The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50–64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.

Suggested Citation

  • Andrea C Villanti & Yiding Jiang & David B Abrams & Bruce S Pyenson, 2013. "A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-11, August.
    • Handle: RePEc:plo:pone00:0071379
    DOI: 10.1371/journal.pone.0071379
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    References listed on IDEAS

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    1. Mucahit Cevik & Mehmet Ali Ergun & Natasha K. Stout & Amy Trentham-Dietz & Mark Craven & Oguzhan Alagoz, 2016. "Using Active Learning for Speeding up Calibration in Simulation Models," Medical Decision Making, , vol. 36(5), pages 581-593, July.
    2. Sébastien Gendarme & Jean-Claude Pairon & Pascal Andujar & François Laurent & Patrick Brochard & Fleur Delva & Bénédicte Clin & Antoine Gislard & Christophe Paris & Isabelle Thaon & Helene Goussault &, 2022. "Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects," Post-Print hal-03783819, HAL.
    3. Carina M. Behr & Martijn J. Oude Wolcherink & Maarten J. IJzerman & Rozemarijn Vliegenthart & Hendrik Koffijberg, 2023. "Population-Based Screening Using Low-Dose Chest Computed Tomography: A Systematic Review of Health Economic Evaluations," PharmacoEconomics, Springer, vol. 41(4), pages 395-411, April.

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