Department of Occupational Health, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, Hokkaido, 061-0293, Japan.
BMC Pulm Med. 2022 Jan 8;22(1):19. doi: 10.1186/s12890-021-01805-y.
Never smokers in Asia have a higher incidence of lung cancer than in Europe and North America. We aimed to assess the cost-effectiveness of lung cancer screening with low-dose computed tomography (LDCT) for never smokers in Japan and the United States.
We developed a state-transition model for three strategies: LDCT, chest X-ray (CXR), and no screening, using a healthcare payer perspective over a lifetime horizon. Sensitivity analyses were also performed. Main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios (ICERs), and deaths from lung cancer. The willingness-to-pay level was US$100,000 per QALY gained.
LDCT yielded the greatest benefits with the lowest cost in Japan, but the ICERs of LDCT compared with CXR were US$3,001,304 per QALY gained for American men and US$2,097,969 per QALY gained for American women. Cost-effectiveness was sensitive to the incidence of lung cancer. Probabilistic sensitivity analyses demonstrated that LDCT was cost-effective 99.3-99.7% for Japanese, no screening was cost-effective 77.7% for American men, and CXR was cost-effective 93.2% for American women. Compared with CXR, LDCT has the cumulative lifetime potential for 60-year-old Japanese to save US$117 billion, increase 2,339,349 QALYs and 3,020,102 LYs, and reduce 224,749 deaths, and the potential for 60-year-old Americans to cost US$120 billion, increase 48,651 QALYs and 67,988 LYs, and reduce 2,309 deaths.
This modelling study suggests that LDCT screening for never smokers has the greatest benefits and cost savings in Japan, but is not cost-effective in the United States. Assessing the risk of lung cancer in never smokers is important for introducing population-based LDCT screening.
亚洲不吸烟人群的肺癌发病率高于欧洲和北美。我们旨在评估在日本和美国从不吸烟者人群中开展低剂量计算机断层扫描（LDCT）肺癌筛查的成本效益。
我们采用医疗保健支付者视角，在终身时间范围内，为三种策略（LDCT、胸部 X 光检查（CXR）和不筛查）开发了状态转换模型。还进行了敏感性分析。主要结局指标是成本、质量调整生命年（QALY）、预期寿命生命年（LY）、增量成本效益比（ICER）和肺癌死亡人数。支付意愿水平为每获得一个质量调整生命年（QALY）支付 10 万美元。
在日本，LDCT 产生的效益最大，成本最低，但与 CXR 相比，美国男性的 LDCT 的增量成本效益比为每获得一个 QALY 支付 3001304 美元，美国女性为每获得一个 QALY 支付 2097969 美元。成本效益对肺癌发病率敏感。概率敏感性分析表明，对于日本人，LDCT 的成本效益为 99.3-99.7%，对于美国男性，不筛查的成本效益为 77.7%，对于美国女性，CXR 的成本效益为 93.2%。与 CXR 相比，LDCT 可使 60 岁的日本人在其有生之年节省 1170 亿美元，增加 2339349 个 QALY 和 3020102 个 LY，并减少 224749 人死亡；而对于 60 岁的美国人，将花费 1200 亿美元，增加 48651 个 QALY 和 67988 个 LY，并减少 2309 人死亡。
这项建模研究表明，在日本，LDCT 筛查从不吸烟人群的获益最大，成本节约最多，但在美国则不具有成本效益。评估从不吸烟者的肺癌风险对于引入基于人群的 LDCT 筛查很重要。
