Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China
Although the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-...
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MDPI AG
2023-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/18/4445 |
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| author | Tiantian Zhang Xudong Chen Caichen Li Xiaoqin Wen Tengfei Lin Jiaxing Huang Jianxing He Nanshan Zhong Jie Jiang Wenhua Liang |
| author_facet | Tiantian Zhang Xudong Chen Caichen Li Xiaoqin Wen Tengfei Lin Jiaxing Huang Jianxing He Nanshan Zhong Jie Jiang Wenhua Liang |
| author_sort | Tiantian Zhang |
| collection | DOAJ |
| description | Although the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-risk population. A Markov model consisting of the natural history and post-diagnosis states was constructed to estimate the costs and quality-adjusted life years (QALYs) of LDCT screening compared with no screening. A total of 36 distinct risk factor-based screening strategies were assessed by incorporating starting ages of 40, 45, 50, 55, 60 and 65 years, stopping ages of 69, 74 and 79 years as well as smoking eligibility criteria. Screening data came from community-based mass screening with LDCT for lung cancer in Guangzhou. Compared with no screening, all screening scenarios led to incremental costs and QALYs. When the willingness-to-pay (WTP) threshold was USD37,653, three times the gross domestic product (GDP) per capita in China, six of nine strategies on the efficiency frontier may be cost-effective. Annual screening between 55 and 79 years of age for those who smoked more than 20 pack-years, which yielded an incremental cost-effectiveness ratio (ICER) of USD35,000.00 per QALY gained, was considered optimal. In sensitivity analyses, the result was stable in most cases. The trends of the results are roughly the same in scenario analyses. According to the WTP threshold of different regions, the optimal screening strategies were annual screening for those who smoked more than 20 pack-years, between 50 and 79 years of age in Zhejiang province, 55–79 years in Guangdong province and 65–74 years in Yunnan province. However, annual screening was unlikely to be cost-effective in Heilongjiang province under our modelling assumptions, indicating that tailored screening policies should be made regionally according to the local epidemiological and economic situation. |
| first_indexed | 2024-03-10T22:57:33Z |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T22:57:33Z |
| publishDate | 2023-09-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-b0ebfeb4da40439b8ea5dd91c93d42e52023-11-19T09:53:56ZengMDPI AGCancers2072-66942023-09-011518444510.3390/cancers15184445Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in ChinaTiantian Zhang0Xudong Chen1Caichen Li2Xiaoqin Wen3Tengfei Lin4Jiaxing Huang5Jianxing He6Nanshan Zhong7Jie Jiang8Wenhua Liang9College of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, ChinaCollege of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, ChinaDepartment of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, ChinaCollege of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, ChinaShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518000, ChinaDepartment of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, ChinaDepartment of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, ChinaDepartment of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, ChinaCollege of Pharmacy/Guangdong-Hong Kong-Marco Greater Bay Area (GBA), Institue for Real-World Value and Evidence of Drugs and Medical Devices/Southern Institute of Pharmacoeconomics and Health Technology Assessment/International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug, Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou 510632, ChinaDepartment of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, ChinaAlthough the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-risk population. A Markov model consisting of the natural history and post-diagnosis states was constructed to estimate the costs and quality-adjusted life years (QALYs) of LDCT screening compared with no screening. A total of 36 distinct risk factor-based screening strategies were assessed by incorporating starting ages of 40, 45, 50, 55, 60 and 65 years, stopping ages of 69, 74 and 79 years as well as smoking eligibility criteria. Screening data came from community-based mass screening with LDCT for lung cancer in Guangzhou. Compared with no screening, all screening scenarios led to incremental costs and QALYs. When the willingness-to-pay (WTP) threshold was USD37,653, three times the gross domestic product (GDP) per capita in China, six of nine strategies on the efficiency frontier may be cost-effective. Annual screening between 55 and 79 years of age for those who smoked more than 20 pack-years, which yielded an incremental cost-effectiveness ratio (ICER) of USD35,000.00 per QALY gained, was considered optimal. In sensitivity analyses, the result was stable in most cases. The trends of the results are roughly the same in scenario analyses. According to the WTP threshold of different regions, the optimal screening strategies were annual screening for those who smoked more than 20 pack-years, between 50 and 79 years of age in Zhejiang province, 55–79 years in Guangdong province and 65–74 years in Yunnan province. However, annual screening was unlikely to be cost-effective in Heilongjiang province under our modelling assumptions, indicating that tailored screening policies should be made regionally according to the local epidemiological and economic situation.https://www.mdpi.com/2072-6694/15/18/4445lung cancerLDCT screeningcurrent smokerscost-effectiveness analysisChina |
| spellingShingle | Tiantian Zhang Xudong Chen Caichen Li Xiaoqin Wen Tengfei Lin Jiaxing Huang Jianxing He Nanshan Zhong Jie Jiang Wenhua Liang Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China Cancers lung cancer LDCT screening current smokers cost-effectiveness analysis China |
| title | Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China |
| title_full | Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China |
| title_fullStr | Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China |
| title_full_unstemmed | Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China |
| title_short | Cost-Effectiveness Analysis of Risk Factor-Based Lung Cancer Screening Program by Low-Dose Computer Tomography in Current Smokers in China |
| title_sort | cost effectiveness analysis of risk factor based lung cancer screening program by low dose computer tomography in current smokers in china |
| topic | lung cancer LDCT screening current smokers cost-effectiveness analysis China |
| url | https://www.mdpi.com/2072-6694/15/18/4445 |
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