South Tyneside and Sunderland NHS Foundation Trust, Respiratory Department, Harton Lane, South Shields NE34 0PL, UK; Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK.
Lung Cancer. 2022 Aug;170:20-33. doi: 10.1016/j.lungcan.2022.05.005. Epub 2022 May 13.
Lung cancer (LC) remains a burden for patients and healthcare systems, with most cases only diagnosed once disease is late stage. Screening for LC with low-dose computed tomography (LDCT) has shown a stage shift and led to a lung cancer-specific mortality reduction. Economic evaluations have been conducted which explore the benefits and costs of screening, however, previous systematic reviews concluded results were heterogeneous. LC screening has evolved and there have been further cost-effectiveness analyses conducted. The aim of this study was to provide an up-to-date systematic review of the cost-effectiveness of LC screening with LDCT.
Databases were searched for full papers published in English 01/1994-02/2022. Inclusion criteria was full economic evaluation of LC screening using LDCT compared to either no screening or chest X-ray.
Forty-five evaluations were identified, three conducted alongside trials and 42 modelling studies. Thirty-nine evaluations (86.7%) found LC screening with LDCT to be cost-effective. Several findings were broadly consistent across studies: cost-effectiveness was optimal in those age 55-75 years and smoking history of at least 20 pack-years. Biennial screening was often more cost-effective than annual screening and would likely result in less additional findings and radiation exposure. A smoking cessation intervention alongside screening improved cost-effectiveness, but which intervention was optimal was unclear. Risk predictions models using more parameters to target participants for screening did not have more benefits than those using age and smoking alone, and cost-effectiveness was equivalent. Cost-effectiveness was sensitive to cost and specificity of LDCT, and disutility associated with screening.
Overall, LC screening with LDCT is cost-effective in a high-risk population. Questions remain regarding risk prediction models, smoking cessation interventions and appropriateness of utility values in the screened population. Once these uncertainties are addressed, further economic evaluation may be required to inform policymakers prior to implementation.
肺癌（LC）仍然给患者和医疗系统带来沉重负担，大多数病例只有在疾病晚期才能确诊。使用低剂量计算机断层扫描（LDCT）进行 LC 筛查已经显示出了疾病分期的转移，并导致了肺癌特异性死亡率的降低。已经进行了经济评估，以探讨筛查的收益和成本，但之前的系统评价得出的结果存在异质性。LC 筛查已经发展，并且已经进行了进一步的成本效益分析。本研究旨在提供使用 LDCT 进行 LC 筛查的成本效益的最新系统评价。
搜索了 1994 年 1 月至 2022 年 2 月期间以英文发表的全文论文数据库。纳入标准为使用 LDCT 对 LC 进行筛查的全经济评估，与不进行筛查或胸部 X 射线相比。
共确定了 45 项评估，其中 3 项是与试验同时进行的，42 项是建模研究。39 项评估（86.7%）发现使用 LDCT 对 LC 进行筛查具有成本效益。几项发现在研究中基本一致：在 55-75 岁年龄组和至少 20 包年吸烟史的人群中，LDCT 筛查的成本效益最佳。每两年进行一次筛查通常比每年进行一次筛查更具成本效益，并且可能会导致更少的额外发现和辐射暴露。在筛查的同时进行戒烟干预可以提高成本效益，但哪种干预措施最有效尚不清楚。使用更多参数来针对参与者进行筛查的风险预测模型并没有比仅使用年龄和吸烟史的模型有更多的获益，并且成本效益是等效的。成本效益对 LDCT 的成本和特异性以及筛查相关的不适度敏感。
总体而言，在高危人群中，使用 LDCT 进行 LC 筛查具有成本效益。关于风险预测模型、戒烟干预以及筛查人群中效用值的适当性，仍存在一些问题。一旦解决了这些不确定性，在实施之前，可能需要进一步的经济评估来为决策者提供信息。
