Cost–effectiveness of lung cancer screening with volume computed tomography in Portugal
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Lung cancer is the most common cause of cancer death in Portugal. The Dutch–Belgian lung cancer screening (LCS) study (NELSON), the biggest European LCS study, showed a lung cancer mortality reduction in a high-risk population when being screened. In this study, the cost–effectiveness of LCS, based on the NELSON study protocol and outcomes, was evaluated compared with no screening in Portugal. Methods: The present study modified an established decision tree by incorporating a state-transition Markov model to evaluate the health-related advantages and economic implications of low-dose computed tomography (LDCT) LCS from the healthcare standpoint in Portugal. The analysis compared screening versus no screening for a high-risk population aged 50–75 with a smoking history. Various metrics, including clinical outcomes, costs, quality-adjusted life years (QALYs), life-years (LYs) and the incremental cost–effectiveness ratio (ICER), were calculated to measure the impact of LDCT LCS. Furthermore, scenario and sensitivity analyses were executed to assess the robustness of the obtained results. Results: Annual LCS with volume-based LDCT resulted in €558 million additional costs and 86,678 additional QALYs resulting in an ICER of €6440 per QALY for one screening group and a lifetime horizon. In total, 13,217 premature lung cancer deaths could be averted, leading to 1.41 additional QALYs gained per individual diagnosed with lung cancer. Results are robust based on the sensitivity analyses. Conclusion: This study showed that annual LDCT LCS for a high-risk population could be cost-effective in Portugal based on a willingness to pay a threshold of one-time the GDP (€19,290 per QALY gained).
Plain language summary
What is this article about?
Various lung cancer screening (LCS) studies have been performed or are currently being performed worldwide. The two biggest LCS studies so far demonstrated that LCS in a high-risk group was able to lower the lung cancer mortality rate. In Portugal, no LCS study or pilot program has started yet. Therefore, this cost–effectiveness analysis could help with the implementation of an LCS pilot in Portugal. The outcomes of this study focus on the economic and clinical aspects of an annual LCS program in Portugal compared with the current situation with no screening program.
What were the results?
LCS, based on the NELSON study protocol and outcomes, improves the clinical outcomes of lung cancer patients while the extra costs are acceptable making it a cost-effective intervention compared with no screening. The incremental cost–effectiveness ratio (ICER) was €6440 per QALY gained at a willingness to pay threshold of one-time the GDP (€19,290).
What do the results mean?
These findings indicate that LCS in Portugal could potentially be a preferred option for diagnosing lung cancer patients compared with the current clinical pathway. The results provide decision-makers with information to consider launching an LCS pilot study to develop the most optimal LCS program in Portugal.
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Received: 2 July 2024
Accepted: 6 September 2024
Published online: 27 September 2024
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Cost–effectiveness of lung cancer screening with volume computed tomography in Portugal. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0102
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