The University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Centre for the Business and Economics of Health (CBEH), The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2019 Nov;49(11):1392-1399. doi: 10.1111/imj.14439.
Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain.
To describe the first direct medical costs associated with lung cancer screening in Australia.
Single-centre prospective screening cohort. Healthy volunteers (age 60-74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack-years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values.
A total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow-up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non-surgical median survival post-diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false-positive scan work-up; AU$96 340 true-positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow-up post-treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non-surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care).
Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.
肺癌筛查可以降低肺癌死亡率。澳大利亚的成本估算对于制定政策很重要，但仍然不确定。
描述澳大利亚首次与肺癌筛查相关的直接医疗成本。
单中心前瞻性筛查队列。健康志愿者（年龄 60-74 岁，当前或曾经吸烟，戒烟时间<15 年，吸烟量≥30 包年）接受了基线和两次年度发病率计算机断层扫描（CT）筛查扫描。在 5 年内收集了健康状况和医疗保健使用数据。主要结局指标是：肺癌的发生率；从多个数据源得出的个人医疗资源使用量，根据 2018 年澳大利亚医疗保险福利表进行了调整。
每次筛查分别有 256、239 和 233 名参与者接受了筛查；在筛查期间诊断出 12 名参与者患有肺癌，在随访期间诊断出 2 名参与者患有肺癌：9 名接受了手术，4 名接受了同步放化疗，1 名接受了姑息化疗。1 例手术病例在诊断后 1407 天因淋巴瘤死亡，所有其他手术病例均存活超过 5 年。非手术中位生存期为 654 天。总试验成本为 965665 澳元（397396 澳元 CT 扫描；29303 澳元假阳性扫描检查；96340 澳元真阳性扫描检查；336914 澳元肺癌治疗；104712 澳元肺癌治疗后随访）。每位参与者的平均直接医疗总成本为 3768 澳元。手术的平均直接成本为 22659 澳元；非手术的平均成本为 47395 澳元（放疗、化疗、姑息治疗）。
晚期癌症的治疗费用更高，生存情况更差。筛查成本与国际研究相似，表明肺癌早期检测可以限制治疗成本并改善预后。
