Cost-Effectiveness Analysis of Lung Cancer Screening in the United States A Comparative Modeling Study
Cost-Effectiveness Analysis of Lung Cancer Screening in the United States A Comparative Modeling Study
复制标题
DOI：
10.7326/m19-0322
复制
发表时间：
2019-12-03
影响因子：
39.2
通讯作者：
Kong, Chung Yin
中科院分区：
文献类型：
--
作者：
Criss, Steven D.;Cao, Pianpian;Kong, Chung Yin
背景：关于停止肺癌筛查的最大年龄建议各不相同：根据美国预防服务工作组（USPSTF）的建议是80岁，根据医疗保险和医疗补助服务中心（CMS）的建议是77岁，根据国家肺部筛查试验（NLST）的建议是74岁。目的：比较不同停药年龄进行肺癌筛查的成本-效果。设计：通过使用吸烟行为、成本和生活质量的共享输入，4个独立开发的微观模拟模型评估了每年使用低剂量计算机断层扫描（LDCT）进行肺癌筛查的健康和成本结果。数据来源：NLST；前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验；SEER（监测、流行病学和最终结果）项目；护士健康调查与卫生专业人员随访研究和美国吸烟历史生成器。目标人群：来自1960年美国出生队列的45岁吸烟者、戒烟者和不吸烟者。时间跨度：45年。展望：保健部门。干预措施：根据NLST、CMS和USPSTF标准进行年度LDCT检查。结果测量：增量成本效益比（ICERs），每个质量调整生命年（QALY）的支付意愿阈值为10万美元。基本病例分析结果：4个模型显示NLST、CMS和USPSTF筛查策略具有成本效益，ICERs平均每个QALY分别为49 200美元、68 600美元和96 700美元。提高停止筛查的年龄可以大大降低死亡率，但也会导致更高的费用和过度诊断率。敏感性分析结果：概率敏感性分析显示，NLST和CMS策略的成本效益概率（分别为98%和77%）高于USPSTF策略（52%）。局限性：假设100%的筛查依从性，模型推断超出临床试验数据。结论：所有3套肺癌筛查标准都是具有成本效益的方案。尽管存在潜在的不确定性，NLST和CMS筛查策略具有很高的成本效益概率。
Background: Recommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST).Objective: To compare the cost-effectiveness of different stopping ages for lung cancer screening.Design: By using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT).Data Sources: The NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses' Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator.Target Population: Current, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort.Time Horizon: 45 years.Perspective: Health care sector.Intervention: Annual LDCT according to NLST, CMS, and USPSTF criteria.Outcome Measures: Incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).Results of Base-Case Analysis: The 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates.Results of Sensitivity Analysis: Probabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%).Limitation: Scenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data.Conclusion: All 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective.