Combined Biomarker and Computed Tomography Screening Strategies for Lung Cancer: Projections of Health and Economic Tradeoffs in the US Population. Issue 1 (July 2016)

• Record Type: Journal Article
• Authors: Kong, Chung Yin; Sheehan, Deirdre F.; McMahon, Pamela M.; Gazelle, G. Scott; Pandharipande, Pari
• Is Part Of: MDM policy & practice. Volume 1:Issue 1(2016)
• Publication Date: 2016-07
• Subjects: biomarker -- screening -- lung cancer -- efficiency frontier -- microsimulation; Medicine -- Decision making -- Periodicals; Medicine -- Decision making; Decision Making; Clinical Medicine; Health Policy; Periodicals; Periodicals; Electronic journals; 616.075
• DOI: 10.1177/2381468316643968
• Languages: English
• ISSNs: 2381-4683

Abstract

Background: Lung cancer screening with computed tomography (CT) of individuals who meet certain age and smoking history criteria is the current standard-of-care.Methods: Using a published simulation model, we compared outcomes associated with seven biomarker + CT screening strategies to CT screening alone using Centers for Medicare & Medicaid Services eligibility criteria. We assumed that the biomarker had conditionally independent performance; was used for first-line screening in some, or all, individuals screened; and could be extended to Centers for Medicare & Medicaid Services–ineligible smokers. Strategies differed by inclusion criteria (e.g., pack-years) and proportion of individuals for whom CT remained the first-line test. Each model run simulated a combined cohort of one million men and one million women born in 1950. Primary outcomes were cancer-specific mortality reduction and screening costs; biomarker costs were measured relative to CT. Efficiency frontiers identified optimal health and economic tradeoffs. Sensitivity analysis evaluated the stability of results.Results: Standard-of-care screening yielded an 8.3% cancer-specific mortality reduction in the simulated US population (screened + unscreened individuals). For a biomarker test with 75% sensitivity and 95% specificity, mortality reductions across biomarker + CT strategies ranged from 7.0% to 23.9%. If the biomarker's cost was >0.86× that of CT, standard-of-care screening remained on the efficiency frontier, indicating that health and economic tradeoffs were equally (or more) efficient relative to all biomarker + CT strategies. Biomarker + CT strategy costs were principally driven by biomarker specificity; mortality reduction was driven by sensitivity.Conclusion: Combined biomarker + CT strategies have the potential to improve future lung cancer screening effectiveness in the United States and achieve economic efficiency that is greater than the current standard-of-care.