Yang Szu-Chun, Lai Wu-Wei, Lin Chien-Chung, Su Wu-Chou, Ku Li-Jung, Hwang Jing-Shiang, Wang Jung-Der
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan.
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan.
Lung Cancer. 2017 Jun;108:183-191. doi: 10.1016/j.lungcan.2017.04.001. Epub 2017 Apr 4.
A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan.
The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective.
The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial.
Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.
肺癌筛查计划需要更多实证依据。基于国家肺癌筛查试验（NLST）的经验，我们开发了一种方法来调整提前期偏倚和生活质量变化，以评估在台湾实施计算机断层扫描（CT）筛查的成本效益。
目标人群为年龄在55至75岁之间、吸烟量≥30包年的高危人群。从一项全国范围的13年随访队列中，我们按病理和分期对肺癌病例的质量调整预期寿命（QALE）、QALE损失以及终身医疗费用进行了估算。假设CT筛查组和未筛查组的累积分期分布与NLST中CT筛查组和X线筛查组的相同，以估算CT筛查后QALE损失的节省情况以及终身医疗费用的额外成本。纳入筛查阴性受试者、假阳性病例和辐射诱发肺癌的成本，从公共支付方的角度获得增量成本效益比。
人均增量成本为22,755美元。将此成本除以QALE损失的节省量（1.16个质量调整生命年（QALY））后，增量成本效益比为每QALY 19,683美元。如果CT筛查的分期分布与NELSON试验中筛查发现癌症的分期分布相同，该比值将降至每QALY 10,947美元。
在台湾，对高危吸烟者进行低剂量CT肺癌筛查具有成本效益。由于我们的女性中只有约5%吸烟，未来有必要开展研究以确定非吸烟者中的高危人群并扩大覆盖范围。
