Estimating the cost-effectiveness of lung cancer screening with low dose computed tomography for high risk smokers in Australia
Menée dans un contexte australien, cette étude évalue le rapport coût-efficacité d'un dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnement, chez des fumeurs à haut risque et âgés de 55 à 74 ans
Background : Health economic evaluations of lung cancer screening with low dose computerised tomography (LDCT) that are underpinned by clinical outcomes are few. Methods : We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers aged 55-74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015); lung cancer diagnosis and treatment costs from a 2012 Australian, hospital-based study; lung cancer survival rates from the New South Wales Cancer Registry (2005-2009); and other-cause mortality from Australian life tables, weighted by smoking status. Health utility outcomes, screening participation and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICERs) were calculated for a ten-year time horizon. Results : LDCT lung screening was estimated at AU$138,000 (80% CI, AU$84,700-$353,000)/life-year gained and AU$233,000 (80% CI, AU$128,000-$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favourable when all-cause mortality and the costs of incidental findings were estimated in sensitivity analyses: AU$157,000/QALY gained This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000-$50,000/QALY. Conclusions : LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternate screening eligibility criteria, intervals, nodule management, the impact and costs of new therapies, investigations of incidental findings, and incorporating smoking cessation interventions.