Tabata Hiroki, Akita Tomoyuki, Matsuura Akiko, Kaishima Terumi, Matsuoka Toshihiko, Ohisa Masayuki, Awai Kazuo, Tanaka Junko
Hiroshima J Med Sci. 2014 Sep;63(1-3):13-22.
The validity of low-dose CT screening for lung cancer in heavy smokers was supported by the results of National Lung Screening Trials (NLST) conducted in the U.S.A. The present study investigated the appropriateness of the introduction of low-dose CT screening for lung cancer in Japanese smokers aged between 55 and 74 years old, in terms of cost-effectiveness and age. To examine changes in the shift from conventional chest radiography (CR) to low-dose CT (LDCT) screening for lung cancer, we estimated the incremental cost-effectiveness ratio (ICER) using Iinuma's mathematical model, and also conducted sensitivity analysis to determine the requirements for the introduction of a population-based screening. As the result, the incremental cost for one life-year saved was one million yen or lower when the costs of the screening were 8,000 and 6,000 yen and the recall rate was 10% for male and female smokers aged 55 to 59 years old, respectively. The recall rate was smaller when the interval between cancer screenings was two years, and the subjects were males. The higher the age of the subject, the smaller the incremental cost. In conclusion, at present, the mean cost of the LDCT test is approximately 10,000 yen in Japan. With a reduction in this cost by a few thousand yen, all Japanese smokers aged 55 to 74 years will be able to undergo LDCT screening for lung cancer annually.
美国进行的国家肺癌筛查试验（NLST）结果支持了低剂量CT筛查对重度吸烟者肺癌的有效性。本研究从成本效益和年龄方面调查了在日本55至74岁吸烟者中引入低剂量CT肺癌筛查的适宜性。为了研究从传统胸部X线摄影（CR）转向低剂量CT（LDCT）肺癌筛查的变化情况，我们使用猪沼的数学模型估计了增量成本效益比（ICER），并进行了敏感性分析以确定引入基于人群筛查的要求。结果显示，对于55至59岁的男性和女性吸烟者，当筛查成本分别为8000日元和6000日元且召回率为10%时，每挽救一个生命年的增量成本为100万日元或更低。当癌症筛查间隔为两年且对象为男性时，召回率更小。受试者年龄越高，增量成本越小。总之，目前在日本，LDCT检查的平均成本约为10000日元。如果该成本降低几千日元，所有55至74岁的日本吸烟者将能够每年接受LDCT肺癌筛查。
