Zhang Tiantian, Wang Yue, Chen Xuechen, Yang Xueer, Zhang Leyao, Bazzi Nagham, Bai Ling, Finley Aaron, Jiang Jie, He Jianxing, Liang Wenhua
College of Pharmacy/Southern Institute of Pharmacoeconomics and Health Technology Assessment, Jinan University, Guangzhou, China.
Department of Pharmacy, The Maternal and Child Health Hospital of Qingyuan, Qingyuan, China.
BMC Med. 2025 May 28;23(1):315. doi: 10.1186/s12916-025-04065-3.
China bears the largest global burden of lung cancer, with a striking 40% of cases occurring in individuals who have never smoked. While the mortality-reducing benefits of low-dose computed tomography (LDCT) for lung cancer screening are established, the quest for an optimal screening strategy continues, considering the potential adverse effects of LDCT. The Chinese NCC-LCm2021 model was developed based on a nationwide population to identify at-risk individuals among smokers and nonsmokers. However, the cost-effectiveness of this model has yet to be determined.
The cost-effectiveness analysis simulates a Chinese birth cohort using a calibrated Markov model based on individual data from a prospective cohort of the Guangzhou Lung Cancer Screening Program. Health utility was extracted from the literature. Cost parameters were obtained from the price of basic medical services in public medical institutions. Our analysis evaluated 236 distinct screening strategies, varying by screening initiation age, risk thresholds, and smoking status. The primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).
For smokers, four strategies on the efficiency frontier yielded incremental QALYs ranging from 0.011 to 0.039 compared to no screening, with ICERs ranging from $21,874 to $55,038 when compared to the previous efficient strategies. The optimal strategy was annual screening of smokers aged 45 years and older with a 3-year risk of lung cancer incidence of 0.55%, offering the largest gain in QALYs at a willingness-to-pay (WTP) threshold of $38,224 (three times GDP per capita). This optimal strategy dominated the 2023 Chinese guideline-recommended strategy. For nonsmokers, the strategies on the efficiency frontier yielded incremental QALYs ranging from 0.006 to 0.041 compared to no screening, with ICERs ranging from $26,517 to $37,994 when compared to the previous efficient strategies. Correspondingly, the optimal strategy is annual screening of nonsmokers aged 45 years and older with a 3-year risk of lung cancer incidence of 0.20%.
This economic evaluation found that lung cancer screening strategies based on the Chinese NCC-LC model were cost-effective for both smokers and non-smokers in China. Furthermore, tailoring risk thresholds to smokers and nonsmokers can enhance the cost-effectiveness of lung cancer screening.
中国承担着全球最大的肺癌负担，其中40%的病例发生在从不吸烟的人群中，这一比例令人震惊。虽然低剂量计算机断层扫描（LDCT）用于肺癌筛查可降低死亡率的益处已得到证实，但考虑到LDCT的潜在不良反应，人们仍在寻求最佳的筛查策略。中国NCC-LCm2021模型是基于全国人口开发的，用于识别吸烟者和非吸烟者中的高危个体。然而，该模型的成本效益尚未确定。
成本效益分析使用基于广州肺癌筛查项目前瞻性队列个体数据校准的马尔可夫模型，模拟中国出生队列。健康效用值从文献中提取。成本参数从公共医疗机构基本医疗服务价格中获取。我们的分析评估了236种不同的筛查策略，这些策略因筛查起始年龄、风险阈值和吸烟状况而异。主要结果是质量调整生命年（QALYs）和增量成本效益比（ICERs）。
对于吸烟者，与不进行筛查相比，效率前沿上的四种策略产生的增量QALYs范围为0.011至0.039，与先前的有效策略相比，ICERs范围为21,874美元至55,038美元。最佳策略是对45岁及以上、肺癌发病3年风险为0.55%的吸烟者进行年度筛查，在支付意愿（WTP）阈值为38,224美元（人均GDP的三倍）时，QALYs收益最大。这一最佳策略优于2023年中国指南推荐的策略。对于非吸烟者，效率前沿上的策略与不进行筛查相比，产生的增量QALYs范围为0.006至0.041，与先前的有效策略相比，ICERs范围为26,517美元至37,994美元。相应地，最佳策略是对45岁及以上、肺癌发病3年风险为0.20%的非吸烟者进行年度筛查。
这项经济评估发现，基于中国NCC-LC模型的肺癌筛查策略对中国的吸烟者和非吸烟者均具有成本效益。此外，针对吸烟者和非吸烟者调整风险阈值可以提高肺癌筛查的成本效益。
