Zhong Danrong, Sidorenkov Grigory, Poelhekken Keris, Du Yihui, Vermeulen Karin M, Vliegenthart Rozemarijn, Heuvelmans Marjolein A, Groen Harry J M, Greuter Marcel J W, de Bock Geertruida H
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands.
Lung Cancer. 2025 Aug;206:108669. doi: 10.1016/j.lungcan.2025.108669. Epub 2025 Jul 16.
Lung cancer screening in high-risk populations with low-dose computed tomography (LDCT) reduces lung cancer mortality by detecting cancer at early stage. Immunotherapy improves survival in these patients. This study evaluates the cost-effectiveness and budget impact of LDCT screening extending immunotherapy to early-stage patients.
A micro-simulation model Simulation Model on Radiation Risk and cancer Screening (SiMRiSc, validated against NELSON results) was used to a Dutch heavy smokers cohort. Average cost-effectiveness ratio (ACER), lung cancer mortality reduction, and budget impact of biennial screening for heavy smokers aged 55-74 (adapted from the UK strategy) were evaluated in context of immunotherapy, compared with no-screening. A cost-effectiveness threshold was set at 60 k€ per life year gained (LYG).
Compared with no-screening, limiting immunotherapy to advanced-stage patients, screening resulted in ACERs of 4.7 k€/LYG for males and 6.6 k€/LYG for females, reducing lung cancer mortality by 18.1 % and 17.1 %, respectively. Extending immunotherapy to all stages increased ACERs to 5.2 k€/LYG for males and 7.1 k€/LYG for females, with lung cancer mortality reduction of 21.1 % and 20.1 %, respectively. Budget impact analysis shows screening saved 35-52 million€ when immunotherapy restricted to advanced-stage, and 24-39 million€ for all stages immunotherapy over three-screening rounds compared with no-screening, primarily due to a 53 % reduction for advanced-stage cases.
Lung cancer screening in high-risk population remains cost-effective when immunotherapy is offered to all stages. By shifting diagnoses from advanced to early stages, screening yielding substantial savings. These findings support LDCT screening implementation even in healthcare systems broadly using immunotherapy.
采用低剂量计算机断层扫描（LDCT）对高危人群进行肺癌筛查，可通过早期发现癌症降低肺癌死亡率。免疫疗法可提高这些患者的生存率。本研究评估了将免疫疗法扩展至早期患者的LDCT筛查的成本效益和预算影响。
使用一个微观模拟模型（辐射风险与癌症筛查模拟模型（SiMRiSc），已根据NELSON研究结果进行验证）对荷兰重度吸烟者队列进行分析。在免疫疗法的背景下，与不进行筛查相比，评估了55 - 74岁重度吸烟者（采用英国策略改编）每两年进行一次筛查的平均成本效益比（ACER）、肺癌死亡率降低情况以及预算影响。设定成本效益阈值为每获得一个生命年（LYG）60,000欧元。
与不进行筛查且仅对晚期患者进行免疫疗法相比，筛查使男性的ACER为4,700欧元/LYG，女性为6,600欧元/LYG，肺癌死亡率分别降低了18.1%和17.1%。将免疫疗法扩展至所有阶段使男性的ACER增至5,200欧元/LYG，女性增至7,100欧元/LYG，肺癌死亡率分别降低了21.1%和20.1%。预算影响分析表明，与不进行筛查相比，在三轮筛查中，当免疫疗法仅限于晚期时，筛查节省了3500万 - 5200万欧元，而对于所有阶段的免疫疗法则节省了2400万 - 3900万欧元，主要原因是晚期病例减少了53%。
当对所有阶段的患者提供免疫疗法时，高危人群的肺癌筛查仍然具有成本效益。通过将诊断从晚期转变为早期，筛查可带来可观的节省。这些发现支持即使在广泛使用免疫疗法的医疗系统中实施LDCT筛查。
