Sheehan Deirdre F, Criss Steven D, Gazelle G Scott, Pandharipande Pari V, Kong Chung Yin
Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2017 Mar 8;12(3):e0173119. doi: 10.1371/journal.pone.0173119. eCollection 2017.
More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare & Medicaid Services (CMS). The China LCPM, built using an existing lung cancer microsimulation model, can project population outcomes associated with interventions for smoking-related diseases. After calibrating the model to published Chinese smoking prevalence and lung cancer mortality rates, we simulated screening from 2016 to 2050 based on eligibility criteria from the CMS and Chinese guidelines, which differ by age to begin and end screening, pack-years smoked, and years since quitting. Outcomes included number of screens, mortality reduction, and life-years saved for each strategy. We projected that in the absence of screening, 14.98 million lung cancer deaths would occur between 2016 and 2050. Screening with the CMS guideline would prevent 0.72 million deaths and 5.8 million life-years lost, resulting in 6.58% and 1.97% mortality reduction in males and females, respectively. Screening with the Chinese guideline would prevent 0.74 million deaths and 6.6 million life-years lost, resulting in 6.30% and 2.79% mortality reduction in males and females, respectively. Through 2050, 1.43 billion screens would be required using the Chinese screening strategy, compared to 988 million screens using the CMS guideline. In conclusion, CT-based lung cancer screening implemented in 2016 and based on the Chinese screening guideline would prevent about 20,000 (2.9%) more lung cancer deaths through 2050, but would require about 445 million (44.7%) more screens than the CMS guideline.
中国超过半数男性为当前吸烟者，西方国家的证据表明，随着中国人口老龄化，吸烟导致的死亡人数将达到前所未有的数量。我们使用中国肺癌政策模型（LCPM）来模拟在中国基于计算机断层扫描（CT）的肺癌筛查效果，将中国专家组2015年发布的筛查指南与美国医疗保险和医疗补助服务中心（CMS）为美国制定的版本的影响进行比较。中国LCPM是在现有的肺癌微观模拟模型基础上构建的，可以预测与吸烟相关疾病干预措施相关的人群结果。在将模型校准到已公布的中国吸烟率和肺癌死亡率后，我们根据CMS和中国指南的资格标准模拟了2016年至2050年的筛查情况，这两个指南在开始和结束筛查的年龄、吸烟包年数以及戒烟年限方面存在差异。结果包括每种策略的筛查次数、死亡率降低情况和挽救的生命年数。我们预计，在没有筛查的情况下，2016年至2050年间将有1498万例肺癌死亡。按照CMS指南进行筛查可预防72万例死亡和580万个生命年损失，男性和女性的死亡率分别降低6.58%和1.97%。按照中国指南进行筛查可预防74万例死亡和660万个生命年损失，男性和女性的死亡率分别降低6.30%和2.79%。到2050年，采用中国筛查策略需要进行14.3亿次筛查，而采用CMS指南则需要9.88亿次筛查。总之，2016年实施的基于中国筛查指南的CT肺癌筛查到2050年可多预防约2万例（2.9%）肺癌死亡，但比CMS指南需要多约4.45亿次（44.7%）筛查。
