Risk-based lung cancer screening may prevent more deaths than current guidelines

1. In terms of early lung cancer death per individual screened, targeting lung cancer mortality risk may improve lung cancer screening efficiency.

2. However, the increases in efficiency were attenuated when measured by life-years, quality-adjusted life-years (QALYs), and cost-effectiveness.

Evidence Rating Level: 2 (Good)         

Study Rundown: Current guidelines for lung cancer screening using low-dose computed tomography (LDCT) do not take into consideration long-term survival differences or cost differences between higher- and lower-risk patients.  This cost-effectiveness analysis calculated the value of individualized risk-based criteria for lung cancer screening in comparison to the National Lung Screening Trial (NLST) eligibility criteria.  Using NLST data, researchers stratified 53 086 participants according to their baseline risk for lung cancer mortality.  Using a multistate prediction model, the authors found that targeting risk may improve the efficiency of screening when measured by early lung cancer death per individual screened.  However, the increases in efficiency were attenuated when measured by life-years, QALYs, and cost-effectiveness.  Considering that high-risk patients cost more to screen and have a reduced life expectancy after any lung cancer survival, the authors suggested that using a risk model is not likely to result in considerable improvement in the cost-effectiveness of lung cancer screening using LDCT (as measured by QALYs gained compared to cost).

A strength of this study is that it takes into consideration differences in long-term survival of lung cancer and quantifies the cost differences between higher- and lower-risk patients.  A limitation of this study is that the study design does not take into account all associated differences between the risk of mortality from lung cancer and quality of life.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Targeting of low-dose CT screening according to the risk of lung-cancer death

In-Depth [cost-effective analysis]: Using data from the NLST regarding 53 086 participants, researchers stratified the participants into deciles based on their 7-year risk of lung cancer mortality. Researchers used a multistate prediction model to measure several outcomes for LDCT compared to chest radiography for each decile.  The researchers found that participants who had a higher risk of death from lung cancer were older, had more comorbidities, and had increased costs related to screening.  For the first 7 years, 1.2 (lowest risk decile) to 9.5 (highest risk decile) deaths due to lung cancer were prevented per 10 000 person-years.  Across risk groups, the gradient of benefits was lessened when measured in life-years and QALYs, and the incremental cost-effectiveness ratios (ICERs) were comparable.  The ICER was $75 000 per QALY and $53 000 per QALY for the lowest and highest risk deciles, respectively.  Participants willing to spend $100 000 per QALY would obtain LDCT screening for all deciles.

Image: PD

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