Cost Effectiveness of Lung Cancer Screening Requires Careful Patient Selection Interview with:
Kevin ten Haaf MSc

Scientific researcher, Public Health
Erasmus Medical Center
Rotterdam What is the background for this study?

Response: Lung cancer screening is currently recommended in the United States, for persons aged 55 through 80 who smoked at least 30 pack-years (the average number of cigarettes smoked per day multiplied by the number of years the person has smoked) and who currently smoke or have quit within the last 15 years. Other countries, such as Canada, are investigating the feasibility of implementing lung cancer screening policies.

However, the cost-effectiveness of lung cancer screening in a population-based setting is uncertain. Concerns have been raised on the feasibility of implementing lung cancer screening policies, especially with regards to the potential costs. In this study, the benefits, harms and costs of implementing lung cancer screening in the province of Ontario, Canada were assessed. What are the main findings?

Response: A microsimulation model was used to analyze 576 lung cancer screening policies with different starting ages, stopping ages, screening intervals and smoking eligibility criteria for persons born between 1940 and 1969 in Ontario, Canada. The most cost-effective policy was annual screening between ages 55 and 75 years old for persons who smoked more than 40 pack-years and who quit less than 10 years ago (or currently smoke). It was estimated that this screening policy would reduce lung cancer mortality by 9.05% compared to no screening, with an incremental cost-effectiveness ratio of $41,136 Canadian dollars per life-year gained.

Overall, policies that applied stringent eligibility criteria (such as requiring more years of heavy smoking to be recommended for screening) were more cost-effective than less stringent eligibility criteria, due to the focus on groups at elevated risk for lung cancer given their smoking history. In addition, policies that recommended annual screening were estimated to be more cost-effective than biennial screening. What should readers take away from your report?

Response: The level of lung cancer risk at which an individual is eligible for lung cancer screening should be considered before implementing lung cancer screening policies, as utilizing loose eligibility criteria which select lower-risk individuals yields non-optimal and potentially cost-ineffective scenarios.

The results of this study suggest that, although annual screening requires an additional number of screening examinations (and is thus more costly) compared with biennial screening, the greater reduction in lung cancer mortality and number of life-years gained outweigh the additional costs. What recommendations do you have for future research as a result of this study?

Response: Future research should investigate the cost-effectiveness of selecting individuals for lung cancer screening based on accurate lung cancer risk prediction models using suitable risk thresholds.
Furthermore, it should be evaluated whether the interval between screenings can be varied based on the results of the previous screening and what impact this has on cost-effectiveness. Is there anything else you would like to add?

Response: Some of the authors are investigators (one being the principal investigator) of the Dutch-Belgian Lung Cancer Screening Trial (Nederlands-Leuvens Longkanker Screenings onderzoek; the NELSON trial). Thank you for your contribution to the community.



Performance and Cost-Effectiveness of Computed Tomography Lung Cancer Screening Scenarios in a Population-Based Setting: A Microsimulation Modeling Analysis in Ontario, Canada

Kevin ten Haaf ,Martin C. Tammem├Ągi,Susan J. Bondy,Carlijn M. van der Aalst,Sumei Gu,S. Elizabeth McGregor,Garth Nicholas,Harry J. de Koning,Lawrence F. Paszat

PLOS Published: February 7, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on February 9, 2017 by Marie Benz MD FAAD