Pertile Paolo, Poli Albino, Dominioni Lorenzo, Rotolo Nicola, Nardecchia Elisa, Castiglioni Massimo, Paolucci Massimo, Mantovani William, Imperatori Andrea
Department of Economics, University of Verona, Via dell'Artigliere 19, 37129 Verona, Italy.
Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
Cost Eff Resour Alloc. 2015 Sep 12;13:15. doi: 10.1186/s12962-015-0041-0. eCollection 2015.
After implementation of the PREDICA annual chest X-ray (CXR) screening program in smokers in the general practice setting of Varese-Italy a significant reduction in lung cancer-specific mortality (18 %) was observed. The objective of this study covering July 1997 through December 2006 was to estimate the cost-effectiveness of this intervention.
We examined detailed information on lung cancer (LC) cases that occurred among smokers invited to be screened in the PREDICA study (Invitation-to-screening Group, n = 5815 subjects) to estimate costs and quality-adjusted life-years (QALYs) from LC diagnosis until death. The control group consisted of 156 screening-eligible smokers from the same area, uninvited and unscreened, who developed LC and were treated by usual care. We calculated the incremental net monetary benefit (INMB) by comparing LC management in screening participants (n = 1244 subjects) and in the Invitation-to-screening group versus control group.
The average number of QALYs since LC diagnosis was 1.7, 1.49 and 1.07, respectively, in screening participants, the invitation-to-screening group, and the control group. The average total cost (screening + management) per LC case was higher in screening participants (€17,516) and the Invitation-to-screening Group (€16,167) than in the control group (€15,503). Assuming a maximum willingness to pay of €30,000/QALY, we found that the intervention was cost-effective with high probability: 79 % for screening participation (screening participants vs. control group) and 95 % for invitation-to-screening (invitation-to-screening group vs. control group).
Based on the PREDICA study, annual CXR screening of high-risk smokers in a general practice setting has high probability of being cost-effective with a maximum willingness to pay of €30,000/QALY.
在意大利瓦雷泽的普通医疗环境中，对吸烟者实施PREDICA年度胸部X光（CXR）筛查计划后，观察到肺癌特异性死亡率显著降低（18%）。本研究涵盖1997年7月至2006年12月，目的是评估该干预措施的成本效益。
我们研究了PREDICA研究中受邀参加筛查的吸烟者（筛查邀请组，n = 5815名受试者）中发生的肺癌（LC）病例的详细信息，以估计从LC诊断到死亡的成本和质量调整生命年（QALY）。对照组由来自同一地区的156名符合筛查条件但未受邀且未接受筛查的吸烟者组成，他们患了LC并接受常规治疗。我们通过比较筛查参与者（n = 1244名受试者）以及筛查邀请组与对照组中LC的管理情况，计算了增量净货币效益（INMB）。
自LC诊断以来，筛查参与者、筛查邀请组和对照组的平均QALY数分别为1.7、1.49和1.07。筛查参与者（17,516欧元）和筛查邀请组（16,167欧元）中每例LC病例的平均总成本（筛查 + 管理）高于对照组（15,503欧元）。假设最大支付意愿为30,000欧元/QALY，我们发现该干预措施很可能具有成本效益：筛查参与（筛查参与者与对照组相比）的概率为79%，筛查邀请（筛查邀请组与对照组相比）的概率为95%。
基于PREDICA研究，在普通医疗环境中对高危吸烟者进行年度CXR筛查，在最大支付意愿为30,000欧元/QALY的情况下，很可能具有成本效益。
