Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Eur J Cancer. 2020 Aug;135:121-129. doi: 10.1016/j.ejca.2020.05.004. Epub 2020 Jun 18.
Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. The aim of this study was to evaluate the cost-effectiveness of lung cancer screening with LDCT in a high-risk population.
The study used an adapted microsimulation model in a cohort of Dutch heavy smokers for a lifetime horizon from a health insurance perspective. The main outcomes included average cost-effectiveness ratio (ACER), incremental cost-effectiveness ratio (ICER) and lung cancer mortality reduction. The comparator was no screening. Scenarios with different screening intervals and starting and stopping ages were evaluated for 100,000 male heavy smokers and 100,000 female heavy smokers. A cost-effectiveness threshold of 60 k€ per life year gained (LYG) was assumed acceptable.
The evaluated screening scenarios yielded ACERs ranging from 17.7 to 32.4 k€/LYG for men and from 17.8 to 32.1 k€/LYG for women. The lung cancer mortality reduction ranged from 9.3% to 16.8% for men and from 7.8% to 13.7% for women. The optimal screening scenario was annual screening from 55 to 80 years for men and biennial screening from 50 to 80 years for women, with an ICER of 51.6 and 45.8 k€ per LYG compared with its previous efficient alternative, respectively. Compared with no screening, the optimal screening scenario yielded an ICER of 27.6 k€/LYG for men and 21.1 k€/LYG for women. The mortality reduction of lung cancer was 15.9% for men and 10.6% for women.
Lung cancer LDCT screening is cost-effective in a high-risk population. The optimal screening scenario is dependent on sex.
低剂量计算机断层扫描（LDCT）肺癌筛查可降低肺癌死亡率。本研究旨在评估高危人群中 LDCT 肺癌筛查的成本效益。
该研究使用适应于荷兰重度吸烟者队列的微模拟模型，从健康保险的角度考虑了终生的情况。主要结果包括平均成本效益比（ACER）、增量成本效益比（ICER）和肺癌死亡率降低。比较组为不筛查。对 10 万名男性重度吸烟者和 10 万名女性重度吸烟者进行了不同筛查间隔和起始与停止年龄的情景评估。假设每获得一个生命年的成本效益阈值为 60 千欧元（LYG）是可以接受的。
评估的筛查方案为男性的 ACER 值在 17.7 至 32.4 千欧元/LYG 之间，女性为 17.8 至 32.1 千欧元/LYG。男性肺癌死亡率降低 9.3%至 16.8%，女性为 7.8%至 13.7%。最佳筛查方案为男性 55 至 80 岁每年筛查一次，女性 50 至 80 岁每两年筛查一次，与之前的有效替代方案相比，ICER 分别为 51.6 和 45.8 千欧元/LYG。与不筛查相比，最佳筛查方案对男性的 ICER 为 27.6 千欧元/LYG，对女性为 21.1 千欧元/LYG。肺癌死亡率降低 15.9%，女性为 10.6%。
在高危人群中，LDCT 肺癌筛查具有成本效益。最佳筛查方案取决于性别。
