Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study
Abstract Background Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-024-03292-4 |
| _version_ | 1797274362634567680 |
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| author | Yin Liu Huifang Xu Lihong Lv Xiaoyang Wang Ruihua Kang Xiaoli Guo Hong Wang Liyang Zheng Hongwei Liu Lanwei Guo Qiong Chen Shuzheng Liu Youlin Qiao Shaokai Zhang |
| author_facet | Yin Liu Huifang Xu Lihong Lv Xiaoyang Wang Ruihua Kang Xiaoli Guo Hong Wang Liyang Zheng Hongwei Liu Lanwei Guo Qiong Chen Shuzheng Liu Youlin Qiao Shaokai Zhang |
| author_sort | Yin Liu |
| collection | DOAJ |
| description | Abstract Background Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals. Methods We conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained. Results Compared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened. Conclusions Risk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit–harm trade-offs and improve the cost-effectiveness of lung cancer screenings. |
| first_indexed | 2024-03-07T14:57:21Z |
| format | Article |
| id | doaj.art-4b6d516b788e482faa590f92ca6088b6 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-07T14:57:21Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-4b6d516b788e482faa590f92ca6088b62024-03-05T19:21:21ZengBMCBMC Medicine1741-70152024-02-0122111810.1186/s12916-024-03292-4Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling studyYin Liu0Huifang Xu1Lihong Lv2Xiaoyang Wang3Ruihua Kang4Xiaoli Guo5Hong Wang6Liyang Zheng7Hongwei Liu8Lanwei Guo9Qiong Chen10Shuzheng Liu11Youlin Qiao12Shaokai Zhang13Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalDepartment of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalAbstract Background Annual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit–harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals. Methods We conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained. Results Compared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened. Conclusions Risk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit–harm trade-offs and improve the cost-effectiveness of lung cancer screenings.https://doi.org/10.1186/s12916-024-03292-4Lung cancerRisk-based screeningBenefitHarmCost-effective |
| spellingShingle | Yin Liu Huifang Xu Lihong Lv Xiaoyang Wang Ruihua Kang Xiaoli Guo Hong Wang Liyang Zheng Hongwei Liu Lanwei Guo Qiong Chen Shuzheng Liu Youlin Qiao Shaokai Zhang Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study BMC Medicine Lung cancer Risk-based screening Benefit Harm Cost-effective |
| title | Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study |
| title_full | Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study |
| title_fullStr | Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study |
| title_full_unstemmed | Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study |
| title_short | Risk-based lung cancer screening in heavy smokers: a benefit–harm and cost-effectiveness modeling study |
| title_sort | risk based lung cancer screening in heavy smokers a benefit harm and cost effectiveness modeling study |
| topic | Lung cancer Risk-based screening Benefit Harm Cost-effective |
| url | https://doi.org/10.1186/s12916-024-03292-4 |
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