Economic impact of using risk models for eligibility selection to the International lung screening Trial.
Economic impact of using risk models for eligibility selection to the International lung screening Trial.
复制标题
使用风险模型选择国际肺部筛查试验资格的经济影响。
DOI：
10.1016/j.lungcan.2022.12.011
复制
发表时间：
2022
期刊：
影响因子：
5.3
通讯作者：
M. Tammemägi
中科院分区：
文献类型：
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作者：
S. Cressman;M. Weber;P. Ngo;S. Wade;S. Behar Harpaz;M. Caruana;A. Tremblay;R. Manser;E. Stone;S. Atkar‐Khattra;D. Karikios;Cheryl Ho;Aleisha Fernandes;Jing Yi Weng;A. Mcwilliams;R. Myers;J. Mayo;J. Yee;R. Yuan;H. Marshall;K. Fong;Stephen Lam;K. Canfell;M. Tammemägi
目的使用风险模型作为肺部筛查的资格标准可以减少基于种族和性别的差异。我们使用国际肺筛查试验(ILST；NCT02871856)的数据来比较使用PLCOm2012风险模型和美国预防服务局基于年龄吸烟史的分类标准(USPSTF-2013)的经济影响。材料与方法在ILST和其他筛查试验的基础上，利用决策分析模型对PLCOm2012与USPSTF-2013进行成本-效果评价。主要结果是2020年国际美元成本(美元)、质量调整寿命年(QALY)和增量净收益(INB，每QALY美元)。次要结果是选择特征和癌症检测率(CDR)。结果与USPSTF-2013标准相比，PLCOm2012风险模型每增加0.2QALY可节省成本355美元(INB=4294美元，支付意愿阈值为20000美元/QALY(95%可信区间：4205-4383美元)。与男性(5221美元和695美元)相比，女性在1.5%和1.7%的6年风险阈值(INB分别为6616美元和6112美元)下使用风险模型更具成本效益。PLCOm2012模型在ILST中选择了更多的女性，更多受过较少正规教育的人，以及更多患有其他呼吸道疾病的人。女性使用风险模型的CDR高于USPSTF-2013标准(风险比=7.67，95%CI：1.87~31.38)。结论PLCOm2012模型节省了成本，增加了QALY，并缓解了在获得筛查方面的社会经济和性别差异。
Objectives Using risk models as eligibility criteria for lung screening can reduce race and sex-based disparities. We used data from the International Lung Screening Trial (ILST; NCT02871856) to compare the economic impact of using the PLCOm2012 risk model or the US Preventative Services’ categorical age-smoking history-based criteria (USPSTF-2013). Materials and Methods The cost-effectiveness of using PLCOm2012 versus USPSTF-2013 was evaluated with a decision analytic model based on the ILST and other screening trials. The primary outcomes were costs in 2020 International Dollars ($), quality-adjusted life-years (QALY) and incremental net benefit (INB, in $ per QALY). Secondary outcomes were selection characteristics and cancer detection rates (CDR). Results Compared with the USPSTF-2013 criteria, the PLCOm2012 risk model resulted in $355 of cost savings per 0.2 QALYs gained (INB= $4294 at a willingness-to-pay threshold of $20 000/QALY (95% CI: $4205–$4383). Using the risk model was more cost-effective in females at both a 1.5% and 1.7% 6-year risk threshold (INB= $6616 and $6112, respectively), compared with males ($5221 and $695). The PLCOm2012 model selected more females, more individuals with fewer years of formal education, and more people with other respiratory illnesses in the ILST. The CDR with the risk model was higher in females compared with the USPSTF-2013 criteria (Risk Ratio= 7.67, 95% CI: 1.87–31.38). Conclusion The PLCOm2012 model saved costs, increased QALYs and mitigated socioeconomic and sex-based disparities in access to screening.