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Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review

Author

Listed:
  • Adam J. N. Raymakers

    (University of British Columbia
    Centre for Health Evaluation and Outcomes Sciences (CHEOS), St Paul’s Hospital)

  • John Mayo

    (University of British Columbia)

  • Stephen Lam

    (British Columbia Cancer Agency
    University of British Columbia)

  • J. Mark FitzGerald

    (University of British Columbia)

  • David G. T. Whitehurst

    (Simon Fraser University
    Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute)

  • Larry D. Lynd

    (University of British Columbia
    Centre for Health Evaluation and Outcomes Sciences (CHEOS), St Paul’s Hospital)

Abstract

Background Lung cancer screening with low-dose computed tomography (LDCT) has been shown to deliver appreciable reductions in mortality in high-risk patients. However, in an era of constrained medical resources, the cost-effectiveness of such a program needs to be demonstrated. Objective The aim of this study was to systematically review the literature analyzing the cost-effectiveness of lung cancer screening using LDCT. Methods We searched MEDLINE, EMBASE, EBM Reviews—Health Technology Assessment, the National Health Service Economic Evaluation Database (NHS-EED), and the Cochrane Database of Systematic Reviews. Due to technological progress in CT, we limited our search to studies published between January 2000 and December 2014. Our search returned 393 unique results. After removing studies that did not meet our inclusion criteria, 13 studies remained. Costs are presented in 2014 US dollars (US$). Results The results from the economic evaluations identified in this review were varied. All identified studies reported outcomes using either additional survival (life-years gained) or quality-adjusted life-years (QALYs gained). Results ranged from US$18,452 to US$66,480 per LYG and US$27,756 to US$243,077 per QALY gained for repeated screening. The results of cost-effectiveness analyses were sensitive to several key model parameters, including the prevalence of lung cancer, cost of LDCT for screening, the proportion of lung cancer detected as localized disease, lead time bias, and, if included, the characteristics of a smoking cessation program. Conclusions The cost-effectiveness of a lung cancer screening program using LDCT remains to be conclusively resolved. It is expected that its cost-effectiveness will largely depend on identifying an appropriate group of high-risk subjects.

Suggested Citation

  • Adam J. N. Raymakers & John Mayo & Stephen Lam & J. Mark FitzGerald & David G. T. Whitehurst & Larry D. Lynd, 2016. "Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 14(4), pages 409-418, August.
    • Handle: RePEc:spr:aphecp:v:14:y:2016:i:4:d:10.1007_s40258-016-0226-5
    DOI: 10.1007/s40258-016-0226-5
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Karl Claxton & Mark Sculpher & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier & Tony O'Hagan, 2005. "Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 339-347, April.
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    1. 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.

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