Rajabi Tanya, Szilberhorn László, Győrbíró Dávid, Tatár Manna, Vokó Zoltán, Nagy Balázs
University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary.
Cancers (Basel). 2024 Aug 23;16(17):2933. doi: 10.3390/cancers16172933.
We aimed to directly compare the cost-effectiveness of Hungarian (following the NELSON trial) and NLST screening protocols, two trials influencing lung-cancer-screening implementation internationally. A decision-analytic model analyzing the cost-effectiveness of Hungarian protocols was manipulated to reflect the protocols of the NLST, while maintaining features specific to the Hungarian healthcare setting. In the Hungarian protocol, there are three possible outcomes to the initial round of screening, positive, negative, and indeterminate, indicating an uncertain degree of suspicion for lung cancer. This protocol differs from the NLST, in which the only possible screening outcomes are positive or negative, with no indeterminate option. The NLST pathway for smokers aged 55-74 resulted in a EUR 43 increase in the total average lifetime costs compared to the Hungarian screening pathway and resulted in a lifetime gain of 0.006 QALYs. The incremental costs and QALYs yielded an ICER of 7875 EUR/QALY. Our results demonstrate that assigning any suspicious LDCT screen as a positive result (NLST protocol) rather than indeterminate (Hungarian protocol) can reduce patient uncertainty and yield a slight QALY gain that is worth the additional use of resources according to Hungary's willingness-to-pay threshold. A stratified analysis by age was also conducted, revealing decreasing cost-effectiveness when screening older cohorts. Our study provides insight into the cost-effectiveness, advantages, and disadvantages of various LDCT screening protocols for lung cancer and can assist other countries as they implement their screening programs.
我们旨在直接比较匈牙利（遵循NELSON试验）和NLST筛查方案的成本效益，这两项试验在国际上影响着肺癌筛查的实施。对一个分析匈牙利方案成本效益的决策分析模型进行了调整，以反映NLST的方案，同时保留匈牙利医疗保健环境的特定特征。在匈牙利方案中，首轮筛查有三种可能的结果：阳性、阴性和不确定，这表明对肺癌的怀疑程度不确定。该方案与NLST不同，在NLST中，唯一可能的筛查结果是阳性或阴性，没有不确定选项。与匈牙利筛查途径相比，55 - 74岁吸烟者的NLST途径使总平均终身成本增加了43欧元，并带来了0.006个质量调整生命年（QALY）的终身收益。增量成本和QALY产生的增量成本效益比（ICER）为7875欧元/QALY。我们的结果表明，将任何可疑的低剂量计算机断层扫描（LDCT）筛查结果判定为阳性结果（NLST方案）而非不确定结果（匈牙利方案），可以减少患者的不确定性，并带来轻微的QALY收益，根据匈牙利的支付意愿阈值，这一收益值得额外使用资源。我们还进行了按年龄分层的分析，结果显示筛查年龄较大的人群时成本效益会降低。我们的研究深入探讨了各种LDCT肺癌筛查方案的成本效益、优缺点，可为其他国家实施筛查计划提供帮助。
