Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, China.
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Front Public Health. 2022 Sep 29;10:977550. doi: 10.3389/fpubh.2022.977550. eCollection 2022.
To compare the cost-effectiveness of undertaking low-dose computed tomography (LDCT) screening for early detection of lung cancer (LC) with different frequencies within the healthcare system of China, and estimate the additional national healthcare expenditure and five-year LC mortality associated with different screening frequencies.
A Markov model was established using national LC epidemiological data from the Chinese Center for Disease Control and Prevention, demographic data from the Chinese Statistical Yearbook, and cost and effectiveness data mainly from the Cancer Screening Program in China. The model included thirty sex-specific screening strategies, which were classified by initial screening age (30, 35, 40, 45, and 50), and screening intervals (intervals at single time point, 1, 2, 5, 10, and 20 years). The main model outputs were incremental cost-effectiveness ratios (ICERs), additional national healthcare expenditure and five-year LC mortality.
The ICERs for LDCT screening strategies vs. non-screening strategy ranged from $16,086 per quality-adjusted life-year (QALY) to $3,675,491 per QALY in the male cohort, and from $36,624 per QALY to $5,943,556 per QALY in the female cohort. The annual increment national healthcare expenditures related to LDCT screening were varied from $0.25 to $13.39 billion, with the lower cost in the cohort with older screening ages and lower screening frequencies. More frequent screening with LDCT was associated with a greater reduction in LC death: an annual LDCT screening was linked to an estimated reduction in five-year LC death by 27.27-29.07%, while a one-off screening was linked to a reduction by 5.56-5.83%.
Under a willingness-to-pay (WTP) threshold of three times the Chinese gross domestic product (GDP) per capita (US $37,654), annual screening with an initiating age at 50 was most cost-effective in both male and female cohorts. By taking into account both the national healthcare expenditures and the effect of LDCT screening, our study results support undertaking LDCT screening annually from 50 years old in general populations.
比较在中国医疗体系中进行低剂量计算机断层扫描（LDCT）筛查以早期发现肺癌（LC）的成本效益，评估不同筛查频率与额外国家医疗保健支出和五年 LC 死亡率的关系。
利用中国疾病预防控制中心的全国 LC 流行病学数据、中国统计年鉴的人口数据以及主要来自中国癌症筛查计划的成本和效果数据，建立了一个马尔可夫模型。该模型包括 30 种按初始筛查年龄（30、35、40、45 和 50 岁）和筛查间隔（单次时间点、1、2、5、10 和 20 年）分类的性别特异性筛查策略。主要模型输出是增量成本效益比（ICER）、额外的国家医疗保健支出和五年 LC 死亡率。
与非筛查策略相比，LDCT 筛查策略的 ICER 在男性队列中为每质量调整生命年（QALY）16086 美元至 3675491 美元，在女性队列中为每 QALY 36624 美元至 5943556 美元。与 LDCT 筛查相关的国家医疗保健支出年度增量从 2.5 亿美元到 133.9 亿美元不等，筛查年龄较大和筛查频率较低的队列成本较低。更频繁的 LDCT 筛查与 LC 死亡人数的减少有关：每年一次的 LDCT 筛查与估计的五年 LC 死亡人数减少 27.27-29.07%相关，而一次性筛查与减少 5.56-5.83%相关。
在愿意支付（WTP）的阈值为中国人均国内生产总值（GDP）的三倍（37654 美元）的情况下，男性和女性队列中，起始年龄为 50 岁的年度筛查最具成本效益。考虑到国家医疗保健支出和 LDCT 筛查的效果，我们的研究结果支持在一般人群中从 50 岁开始每年进行 LDCT 筛查。
