Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting

Manser, Renee, Dalton, Andrew, Carter, Rob, Byrnes, Graham, Elwood, Mark and Campbell, Donald A. 2005, Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting, Lung Cancer, vol. 48, no. 2, pp. 171-185.

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Title Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting
Author(s) Manser, Renee
Dalton, Andrew
Carter, Rob
Byrnes, Graham
Elwood, Mark
Campbell, Donald A.
Journal name Lung Cancer
Volume number 48
Issue number 2
Start page 171
End page 185
Publisher Elsevier Ireland Ltd.
Place of publication Shannon, County Clare, Ireland
Publication date 2005-05
ISSN 0169-5002
1872-8332
Keyword(s) lung neoplasm
computed tomography
mass screening
screening
economic evaluation
cost-effectiveness
Summary Introduction:
Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials.
Methods:
We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer.
Results:
For male smokers aged 60–64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was $57,325 per life-year saved and $105,090 per QALY saved. For females aged 60–64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was $51,001 per life-year saved and $88,583 per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of $50,000 per life-year saved as the threshold to define a “cost-effective” intervention.
Conclusion:
The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.
Language eng
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2004, Elsevier Ireland Ltd
Persistent URL http://hdl.handle.net/10536/DRO/DU:30009390

Document type: Journal Article
Collection: School of Health and Social Development
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