Economic impact of using risk models for eligibility selection to the International lung screening Trial. (February 2023)

• Record Type: Journal Article
• Authors: Cressman, Sonya; Weber, Marianne F.; Ngo, Preston J.; Wade, Stephen; Behar Harpaz, Silvia; Caruana, Michael; Tremblay, Alain; Manser, Renee; Stone, Emily; Atkar-Khattra, Sukhinder; Karikios, Deme; Ho, Cheryl; Fernandes, Aleisha; Yi Weng, Jing; McWilliams, Annette; Myers, Renelle; Mayo, John; Yee, John; Yuan, Ren; Marshall, Henry M; Fong, Kwun M; Lam, Stephen; Canfell, Karen; Tammemägi, Martin C
• Is Part Of: Lung cancer. Volume 176(2023)
• Page Start: 38
• Page End: 45
• Publication Date: 2023-02
• Subjects: Lung screening -- Lung cancer screening -- Cost-effectiveness -- Economic impact -- Equity impact -- Health equity -- Risk model -- PLCOm2012 -- USPSTF2013 -- Eligibility criteria -- Screening selection; 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.2022.12.011
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Using the PLCOm2012 risk model saves costs and improves outcomes compared with age-smoking history categorical methods. The risk model mitigated gender-based and socioeconomic disparities in access to lung screening. The PLCOm2012 risk model was most cost-effective for females and at a 1.5 %/6 year threshold for both sexes. Our findings call for deeper inquiry into screening eligibility processes through a sex and gender plus-based lens. Abstract: Objectives: Using risk models as eligibility criteria for lung screening can reduce race and sex-based disparities. We used data from the International Lung Screening Trial (ILST; NCT02871856) to compare the economic impact of using the PLCOm2012 risk model or the US Preventative Services' categorical age-smoking history-based criteria (USPSTF-2013). Materials and Methods: The cost-effectiveness of using PLCOm2012 versus USPSTF-2013 was evaluated with a decision analytic model based on the ILST and other screening trials. The primary outcomes were costs in 2020 International Dollars ($), quality-adjusted life-years (QALY) and incremental net benefit (INB, in $ per QALY). Secondary outcomes were selection characteristics and cancer detection rates (CDR). Results: Compared with the USPSTF-2013 criteria, the PLCOm2012 risk model resulted in $355 of cost savings per 0.2 QALYs gained (INB=$4294 at a willingness-to-pay threshold of $20 000/QALY (95 %CI: $4205–$4383). Using the risk model was more cost-effective in females at both a 1.5 % and 1.7 % 6-year risk threshold (INB=$6616 and $6112, respectively), compared with males ($5221 and $695). The PLCOm2012 model selected more females, more individuals with fewer years of formal education, and more people with other respiratory illnesses in the ILST. The CDR with the risk model was higher in females compared with the USPSTF-2013 criteria (Risk Ratio = 7.67, 95 % CI: 1.87–31.38). Conclusion: The PLCOm2012 model saved costs, increased QALYs and mitigated socioeconomic and sex-based disparities in access to screening.