Poon Charlotte, Haderi Artes, Roediger Alexander, Yuan Megan
Charles River Associates, 8 Finsbury Circus, London EC2M 7EA, UK.
Global Oncology Policy, MSD International Business GmbH, Ringstrasse 27, Kriens 6010, Switzerland.
Health Policy. 2022 Sep;126(9):879-888. doi: 10.1016/j.healthpol.2022.06.003. Epub 2022 Jun 7.
The need for early detection, both early diagnosis and screening is essential for improved prognosis in lung cancer. The effectiveness of lung cancer screening using low-dose computed tomography (LDCT) for high-risk patients has been shown by extensive clinical evidence including the National Lung Cancer Screening Trial (NLST) and the Dutch-Belgian lung cancer screening trial (NELSON) which has triggered political consideration of a formal programme across countries. However, implementation of these is still limited. This study investigates how governments make decisions on the implementation of lung cancer screening, identifying key consideration factors through 10 case study countries: Australia, Canada, Croatia, France, Germany, Japan, South Korea, Switzerland, UK, and US. We identified five decision-making factors (1) recognition of the disease burden and the value of early detection, (2) strong clinical data showing mortality reduction and benefit-risk analysis relevant to the local context, (3) cost-effectiveness data and budget impact, (4) local feasibility demonstration and (5) a clear and integrated decision-making mechanism involving relevant stakeholders. The set of factors identified in this paper can help advocates address knowledge gaps, identify the key focus areas for discussions with policymakers evaluating the opportunities for lung cancer screening programmes in their local context. Ultimately, this should allow policymakers to make more informed decisions on lung cancer screening to best improve lung cancer outcomes.
早期发现，即早期诊断和筛查，对于改善肺癌预后至关重要。包括美国国家肺癌筛查试验（NLST）和荷兰-比利时肺癌筛查试验（NELSON）在内的大量临床证据表明，使用低剂量计算机断层扫描（LDCT）对高危患者进行肺癌筛查是有效的，这引发了各国对正式筛查计划的政策考量。然而，这些计划的实施仍然有限。本研究调查了各国政府如何就肺癌筛查的实施做出决策，通过澳大利亚、加拿大、克罗地亚、法国、德国、日本、韩国、瑞士、英国和美国这10个案例研究国家确定了关键考虑因素。我们确定了五个决策因素：（1）对疾病负担和早期发现价值的认识；（2）显示死亡率降低的有力临床数据以及与当地情况相关的效益风险分析；（3）成本效益数据和预算影响；（4）当地可行性证明；（5）一个涉及相关利益攸关方的清晰且综合的决策机制。本文确定的这组因素有助于倡导者填补知识空白，确定与政策制定者讨论的关键重点领域，以便在当地背景下评估肺癌筛查计划的机会。最终，这应能使政策制定者在肺癌筛查方面做出更明智的决策，以最佳方式改善肺癌治疗效果。
