Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2022 Jul;54(3):728-736. doi: 10.4143/crt.2021.480. Epub 2021 Sep 24.
The aim of this study was to evaluate the cost utility of a pilot study of Korean Lung Cancer Screening Project.
We constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55-74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate.
The base case (US$25,383 per quality-adjusted life year gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution.
Our results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.
本研究旨在评估韩国肺癌筛查项目试点研究的成本效用。
我们根据肺癌的自然史，根据监测、流行病学和最终结果总结阶段（局部、区域、远处），构建了一个由 26 个状态组成的马尔可夫模型。在基本情况下，考虑对 55-74 岁的人群进行年度筛查。模拟成本和质量调整生命年来计算增量成本效用比。对与筛查目标年龄、阶段分布、成本、效用、死亡率、筛查持续时间和贴现率相关的不确定性进行了敏感性分析。
与不进行筛查的情况相比，基本情况（每获得一个质量调整生命年的成本为 25383 美元）具有成本效益，并且在每获得一个质量调整生命年的支付意愿阈值为 27000 美元的情况下是可以接受的。就筛查的目标年龄而言，60-74 岁之间的年龄是最具成本效益的。在对治疗成本、效用、死亡率、筛查持续时间和低于 5%的贴现率进行敏感性分析时，肺癌筛查仍然具有成本效益，尽管结果对阳性率的上升或阶段分布的变化较为敏感。
我们的研究结果表明，对高危人群进行年度低剂量计算机断层扫描筛查肺癌具有成本效益。
