de Nijs Koen, Ten Haaf Kevin, Moldovanu Dana, Hubert Juul, van den Bosch Isabelle, Eijkelboom Anouk, van der Aalst Carlijn, de Koning Harry J
Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, 3015 CE, the Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Rijnkade 5, Utrecht, 3511 CV, the Netherlands.
EClinicalMedicine. 2025 Aug 29;88:103446. doi: 10.1016/j.eclinm.2025.103446. eCollection 2025 Oct.
With the introduction of immune- and targeted therapies, lung cancer survival has lengthened, but per-patient costs of treatment have also increased. Both the clinical outcomes and costs of late stage disease have bearing on the benefits and relative cost of early detection interventions. Cost-effectiveness estimates of lung cancer (LC) computed tomography (CT) screening, crucial for policymaking, using such real-world recent data have been limited.
Registry data of the entire Dutch LC patient population (n = 137,129) inform treatment cost and real-world survival before (2012-2017) and after (2018-2021) widespread novel therapy introduction. The MISCAN-Lung (MIcrosimulation SCreening Analysis) microsimulation model projects the population-level benefits and harms of CT screening for Dutch 1949-1979 cohorts.
From 2012-2017 to 2018-2021, per-patient care expenditures increased 52%. Survival improvements differ by patient subgroup; for males <65 y, 3-year relative survival for stage-IV adenocarcinoma increased from 10.6% to 22%. MISCAN model simulations found annual screening ages 55-75 from 1.51% PLCOm-risk (Prostatem Lung Colorectal Ovarian Screening trial model) as cost-effective (<€20,000 per Quality Adjusted Life Years Gained (QALYG)). After adjusting LC survival to novel therapies, screening is expected to yield 3253 QALYG and 4118 LYG per 100,000 population, 3.2% (QALYG) and 3.7% (LYG) lower than before novel therapies. However, expected net screening costs decrease 16.7% as late-stage treatment has become more expensive and is applied longer; the savings in late-stage therapy cost were estimated to have increased 183%. The cost per QALYG decreased 13.9%, from €14,172/QALY to €12,201/QALY.
Novel treatments for late-stage lung cancer have made lung cancer screening more cost-effective. While LC survival improves due to novel treatments for advanced disease, the increased expenditures outpace survival gains. Screening implementation still needs prioritization, even as late-stage LC survival improves.
European Union Horizon 2020 grant 848294: 4-IN-THE-LUNG-RUN. VENI grant number 09150161910060 (Dutch Research Council/Netherlands Organisation of Health Research (ZonMW)).
随着免疫疗法和靶向疗法的引入，肺癌患者的生存期延长，但每位患者的治疗成本也有所增加。晚期疾病的临床结果和成本对早期检测干预措施的益处和相对成本都有影响。利用此类最新真实世界数据对肺癌（LC）计算机断层扫描（CT）筛查进行成本效益评估，这对政策制定至关重要，但相关研究一直有限。
荷兰全部LC患者群体（n = 137,129）的登记数据提供了广泛引入新型疗法之前（2012 - 2017年）和之后（2018 - 2021年）的治疗成本和真实世界生存期信息。MISCAN - Lung（微观模拟筛查分析）微观模拟模型预测了荷兰1949 - 1979年出生队列进行CT筛查的人群水平的益处和危害。
从2012 - 2017年到2018 - 2021年，每位患者的护理支出增加了52%。生存改善情况因患者亚组而异；对于年龄<65岁的男性，IV期腺癌的3年相对生存率从10.6%提高到了22%。MISCAN模型模拟发现，对于PLCOm风险（前列腺、肺、结肠、卵巢筛查试验模型）为1.51%的人群，55 - 75岁进行年度筛查具有成本效益（每获得一个质量调整生命年（QALYG）<20,000欧元）。在将LC生存期调整为新型疗法后的情况后，预计每10万人进行筛查可产生3253个QALYG和4118个生命年增益（LYG），比新型疗法之前分别降低了3.2%（QALYG）和3.7%（LYG）。然而，由于晚期治疗变得更加昂贵且应用时间更长，预计筛查的净成本降低了16.7%；晚期治疗成本的节省估计增加了183%。每个QALYG的成本降低了13.9%，从14,172欧元/QALY降至12,201欧元/QALY。
晚期肺癌的新型治疗方法使肺癌筛查更具成本效益。虽然由于晚期疾病的新型治疗方法LC生存期有所改善，但增加的支出超过了生存获益。即使晚期LC生存期有所改善，筛查实施仍需确定优先顺序。
欧盟地平线2020资助项目848294：4 - IN - THE - LUNG - RUN。VENI资助编号09150161910060（荷兰研究委员会/荷兰卫生研究组织（ZonMW））
