Economic Evaluation of Low-dose Computed Tomography for Lung Cancer Screening Among High-risk Individuals - Evidence from Hungary Based on the HUNCHEST-II Study

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2024 Dec 3

PMID 39627793

Authors

Peter Rozsa

Anna Kerpel-Fronius

Matyas Peter Muranyi

Agnes Rumszauer

Gabriella Merth

Zsolt Markoczy

Peter Csanyi

Krisztina Bogos

Affiliations

Soon will be listed here.

Abstract

Background: Lung cancer (LC) is the leading cause of cancer-related death in Hungary. Early diagnosis of LC contributes to delivering survival benefits to patients. Low-dose computer tomography (LDCT) is an imaging technology that can be used to identify smaller nodules. The aim of this study was to investigate the cost-effectiveness of introducing organised LDCT screening in Hungary among individuals aged 50 to 74 years with high-risk for developing LC using clinical effectiveness and resource utilisation inputs based on the recent HUNCHEST-II clinical trial.

Methods: We estimated costs and outcomes in a cost-utility analysis framework over the time horizon of 30 years to compare annual and biennial screening for LC with LDCT against standard screening. The economic evaluation simulated a cohort of current and former smokers aged 50 to 74 years with a smoking exposure of at least 25 pack-years, using data from HUNCHEST-II, a multicentre study to evaluate the impact of LDCT screening on early detection of LC. Complementary data were retrieved from published studies and interviews with local experts.

Results: The results of the analysis are favourable from an economic perspective: the introduction of biennial screening for LC with LDCT yielded an incremental effectiveness of 0.031 QALYs as well as an increase in costs of 306 764 HUFs over the 30-year -time horizon when compared to standard screening. The value of the base case ICER (9 908 100 HUF/QALY) of biennial screening for LC with LDCT over standard screening was below the relevant cost-effectiveness threshold. Applying an annual screening strategy using LDCT yielded even more favourable cost-effectiveness results (ICER = 7 927 455 HUF/QALY) compared to biennial screening. Notably, the cost-effectiveness of biennial screening was extendedly dominated by annual screening.

Conclusions: Along with the mature data on its effectiveness, our analysis confirms that using LDCT for LC screening among high-risk individuals is a cost-effective alternative of standard screening in Hungary. Funding a nationwide lung screening program that uses LDCT is a justified decision in economic terms; annual screening would be the optimal strategy to maximize health benefits; however in case of limited financial resources, biennial LDCT screening could offer a cost saving alternative for marginally less health gains than annual screening.

References

Behar Harpaz S, Weber M, Wade S, Ngo P, Vaneckova P, Sarich P . Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes. Br J Cancer. 2022; 128(1):91-101. DOI: 10.1038/s41416-022-02026-8. View

Janssen M, Pickard A, Shaw J . General population normative data for the EQ-5D-3L in the five largest European economies. Eur J Health Econ. 2021; 22(9):1467-1475. PMC: 8558182. DOI: 10.1007/s10198-021-01326-9. View

Grover H, King W, Bhattarai N, Moloney E, Sharp L, Fuller L . Systematic review of the cost-effectiveness of screening for lung cancer with low dose computed tomography. Lung Cancer. 2022; 170:20-33. DOI: 10.1016/j.lungcan.2022.05.005. View

Kerpel-Fronius A, Megyesfalvi Z, Markoczy Z, Solymosi D, Csanyi P, Tisza J . HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. Eur Radiol. 2023; 34(5):3462-3470. DOI: 10.1007/s00330-023-10379-8. View

Nagy B, Szilbehorn L, Kerpel-Fronius A, Moizs M, Bajzik G, Voko Z . The budget impact of lung cancer screening with low-dose computed tomography. Orv Hetil. 2021; 162(24):952-959. DOI: 10.1556/650.2021.32095. View

Brodersen J, Voss T, Martiny F, Siersma V, Barratt A, Heleno B . Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials. Breathe (Sheff). 2020; 16(1):200013. PMC: 7078745. DOI: 10.1183/20734735.0013-2020. View

Poon C, Wilsdon T, Sarwar I, Roediger A, Yuan M . Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption. Front Public Health. 2023; 11:1264342. PMC: 10666168. DOI: 10.3389/fpubh.2023.1264342. View

Brodersen J, Schwartz L, Woloshin S . Overdiagnosis: how cancer screening can turn indolent pathology into illness. APMIS. 2014; 122(8):683-9. DOI: 10.1111/apm.12278. View

Courtney P, Yip A, Cherry D, Salans M, Kumar A, Murphy J . Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non-Small Cell Lung Cancer. JAMA Netw Open. 2021; 4(5):e218787. PMC: 8094011. DOI: 10.1001/jamanetworkopen.2021.8787. View

10.

Ionova Y, Vuong W, Sandoval O, Fong J, Vu V, Zhong L . Cost-Effectiveness Analysis of Atezolizumab Versus Durvalumab as First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer in the USA. Clin Drug Investig. 2022; 42(6):491-500. PMC: 9188525. DOI: 10.1007/s40261-022-01157-3. View

11.

Quaife S, Ruparel M, Dickson J, Beeken R, McEwen A, Baldwin D . Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials. Am J Respir Crit Care Med. 2019; 201(8):965-975. PMC: 7159423. DOI: 10.1164/rccm.201905-0946OC. View

12.

Kiss Z, Galffy G, Muller V, Moldvay J, Sarosi V, Papai-Szekely Z . Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic. Front Oncol. 2023; 13:1207295. PMC: 10584310. DOI: 10.3389/fonc.2023.1207295. View

13.

Lopez-Olivo M, Maki K, Choi N, Hoffman R, Shih Y, Lowenstein L . Patient Adherence to Screening for Lung Cancer in the US: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020; 3(11):e2025102. PMC: 7670313. DOI: 10.1001/jamanetworkopen.2020.25102. View

14.

Aberle D, Berg C, Black W, Church T, Fagerstrom R, Galen B . The National Lung Screening Trial: overview and study design. Radiology. 2010; 258(1):243-53. PMC: 3009383. DOI: 10.1148/radiol.10091808. View

15.

Bonney A, Malouf R, Marchal C, Manners D, Fong K, Marshall H . Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev. 2022; 8:CD013829. PMC: 9347663. DOI: 10.1002/14651858.CD013829.pub2. View

16.

Peters J, Snowsill T, Griffin E, Robinson S, Hyde C . Variation in Model-Based Economic Evaluations of Low-Dose Computed Tomography Screening for Lung Cancer: A Methodological Review. Value Health. 2022; 25(4):656-665. DOI: 10.1016/j.jval.2021.11.1352. View

17.

de Koning H, van der Aalst C, de Jong P, Scholten E, Nackaerts K, Heuvelmans M . Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020; 382(6):503-513. DOI: 10.1056/NEJMoa1911793. View

18.

Nagy B, Szilberhorn L, Gyorbiro D, Moizs M, Bajzik G, Kerpel-Fronius A . Shall We Screen Lung Cancer With Low-Dose Computed Tomography? Cost-Effectiveness in Hungary. Value Health Reg Issues. 2022; 34:55-64. DOI: 10.1016/j.vhri.2022.10.002. View