Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Health Science Center, Yangtze University, Jingzhou, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Int J Nurs Stud. 2022 Oct;134:104319. doi: 10.1016/j.ijnurstu.2022.104319. Epub 2022 Jun 30.
The appropriate screening inclusion criteria of low-dose computed tomography screening for lung cancer in Chinese population remains unclear and the effect of combining screening with nurse-led smoking cessation intervention is poorly understood as well.
We compared the benefits and costs of lung cancer screening with and without nurse-led smoking cessation intervention in different inclusion criteria to help select optimal screening strategies.
Different screening strategies were set based on diverse starting ages, smoking pack-year and whether nurse-led smoking cessation intervention was applied. We use nationally representative data published by the China Health and Retirement Longitudinal Survey, based on a microsimulation model, to predict incremental cost-effectiveness ratio and net health benefits under different strategies.
The incremental cost-effectiveness ratios for all lung cancer screening strategies were less than three times GDP per capita, and screening combined with smoking cessation intervention had lower incremental cost-effectiveness ratios. The largest net health benefits and probability of cost-effectiveness were both obtained in the strategy which conducted screening and nurse-led smoking cessation intervention for people over 45 years with at least 20 pack-year smoking history. In strategies screening alone, it was obtained in screening for people over 50 years and with at 20 pack-year smoking history.
Nurse-led smoking cessation intervention is recommended provided in conjunction with lung cancer screening. The optimal strategy is conducted screening with cessation intervention for current smokers or smoking quitters in the past 15 years who are over 45 years with at least 20 pack-year smoking history. For strategies screening alone, the target population should be over 50 years old with at least 20 pack year smoking history, when willingness to pay less than three times GPD per capita.
中国人群进行低剂量 CT 肺癌筛查的适宜筛查纳入标准仍不清楚，联合筛查与护士主导的戒烟干预的效果也知之甚少。
我们比较了不同纳入标准下进行肺癌筛查与不进行护士主导的戒烟干预的获益和成本，以帮助选择最佳的筛查策略。
根据不同的起始年龄、吸烟包年数以及是否应用护士主导的戒烟干预，设定了不同的筛查策略。我们使用中国健康与退休纵向调查公布的全国代表性数据，基于一个微观模拟模型，预测不同策略下的增量成本效益比和净健康效益。
所有肺癌筛查策略的增量成本效益比均低于人均 GDP 的三倍，且筛查联合戒烟干预的增量成本效益比更低。在 45 岁以上、吸烟包年数至少为 20 年且接受过护士主导的戒烟干预的人群中，筛查联合戒烟干预策略获得的净健康效益最大且具有成本效益的概率最高。在单独筛查的策略中，在 50 岁以上、吸烟包年数至少为 20 年的人群中获得了最大的净健康效益和具有成本效益的概率。
建议在进行肺癌筛查的同时，提供护士主导的戒烟干预。最佳策略是对过去 15 年内 45 岁以上、吸烟包年数至少为 20 年的当前吸烟者或戒烟者进行筛查和戒烟干预。对于单独筛查的策略，当支付意愿低于人均 GDP 的三倍时，目标人群应为 50 岁以上、吸烟包年数至少为 20 年的人群。
