Favorable incremental cost-effectiveness ratio for lung cancer screening in Italy. (May 2020)

• Record Type: Journal Article
• Authors: Veronesi, Giulia; Navone, Niccolò; Novellis, Pierluigi; Dieci, Elisa; Toschi, Luca; Velutti, Laura; Solinas, Michela; Vanni, Elena; Alloisio, Marco; Ghislandi, Simone
• Is Part Of: Lung cancer. Volume 143(2020)
• Page Start: 73
• Page End: 79
• Publication Date: 2020-05
• Subjects: Lung cancer screening -- Low dose computed tomography -- Cost effectiveness analysis -- Quality of life; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.03.015
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: NELSON trial showed reduced mortality in the screened arm compared to control. Resources will be made available to offer LDCT screening to high-risk subjects. We found a low ICER per QALY for LDCT lung cancer screening in Italy. Screening can be introduced at contained cost, saving lives of many patients. Abstract: Objectives: Lung cancer detection by low-dose computed tomographic screening reduces mortality. However, it is essential to assess cost-effectiveness. We present a cost-effectiveness analysis of screening in Italians at high risk of lung cancer, from the point of view of the Italian tax-payer. Materials and methods: We used a decision model to estimate the cost-effectiveness of annual screening for 5 years in smokers (≥30 pack-years) of 55–79 years. Patients diagnosed in the COSMOS study were the screening arm; patients diagnosed and treated for lung cancer in the Lombardy Region, Italy, constituted the usual care arm. Treatment costs were extracted from our hospital database. Lung cancer survival in screened patients was adjusted for 2-year lead-time bias. Life-years and quality-adjusted life-years were estimated by stage at diagnosis, from which incremental cost-effectiveness ratios per life-year and quality-adjusted life-year gained were estimated. Results: Base-case incremental cost-effectiveness ratios were 3297 and 2944 euro per quality-adjusted life-year and life-year gained, respectively. Deterministic sensitivity analysis indicated that these values were particularly sensitive to lung cancer prevalence, screening sensitivity and specificity, screening cost, and treatment costs for stage I and IV disease. From the probabilistic sensitivity analysis incremental cost-effectiveness ratios had a 98 % probability of being <25, 000 euro (widely-accepted threshold) and a 55 % probability of being <5000 euro. Conclusions: Low-dose computed tomographic screening is associated with an incremental cost of 2944 euro per life-year gained in high risk population, implying that screening can be introduced in Italy at contained cost, saving the lives of many lung cancer patients.