Cost-effectiveness of CT screening in the National Lung Screening Trial.
Cost-effectiveness of CT screening in the National Lung Screening Trial.
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DOI：
10.1056/nejmoa1312547
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发表时间：
2014-11-06
期刊：
影响因子：
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通讯作者：
National Lung Screening Trial Research Team
中科院分区：
文献类型：
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作者：
Black WC;Gareen IF;Soneji SS;Sicks JD;Keeler EB;Aberle DR;Naeim A;Church TR;Silvestri GA;Gorelick J;Gatsonis C;National Lung Screening Trial Research Team
国家肺部筛查试验(NLST)显示，与胸部X光检查相比，使用低剂量计算机断层扫描(CT)筛查可降低肺癌死亡率。我们研究了在NLST中使用低剂量CT进行筛查的成本-效果。我们估计了三种替代策略的平均寿命年、质量调整寿命年(QALY)、人均成本和增量成本-效果比(ICER)：低剂量CT筛查、放射成像筛查和不筛查。对寿命年的估计是基于试验期间观察到的死亡人数和试验结束时活着的人的预计存活率。质量调整是从被选中完成生活质量调查的参与者的子组中得出的。费用是基于使用率和医疗保险报销。我们还对根据年龄、性别、吸烟史和肺癌风险定义的亚组进行了分析，并根据几个假设进行了敏感性分析。与不进行筛查相比，使用低剂量CT进行筛查的人均成本增加了1,631美元(95%可信区间为1,557至1,709)，人均寿命增加了0.0316年(95%可信区间为0.0154至0.0478)，人均生存质量年数增加了0.0201次(95%可信区间为0.0088至0.0314)。相应的ICER为每生命年收益52,000美元(95%CI，34,000至106,000)和每QALY收益81,000美元(95%CI，52,000至186,000)。然而，ICER在亚组和敏感性分析中差异很大。我们估计，使用低剂量CT筛查肺癌每增加一个QALY将花费81,000美元，但我们也确定，我们假设的适度变化将极大地改变这一数字。试验外筛查是否具有成本效益将取决于筛查是如何实施的。(由国家癌症研究所资助；NLST ClinicalTrials.gov编号，NCT00047385。)
The National Lung Screening Trial (NLST) showed that screening with low-dose computed tomography (CT) as compared with chest radiography reduced lung-cancer mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST. We estimated mean life-years, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratios (ICERs) for three alternative strategies: screening with low-dose CT, screening with radiography, and no screening. Estimations of life-years were based on the number of observed deaths that occurred during the trial and the projected survival of persons who were alive at the end of the trial. Quality adjustments were derived from a subgroup of participants who were selected to complete quality-of-life surveys. Costs were based on utilization rates and Medicare reimbursements. We also performed analyses of subgroups defined according to age, sex, smoking history, and risk of lung cancer and performed sensitivity analyses based on several assumptions. As compared with no screening, screening with low-dose CT cost an additional $1,631 per person (95% confidence interval [CI], 1,557 to 1,709) and provided an additional 0.0316 life-years per person (95% CI, 0.0154 to 0.0478) and 0.0201 QALYs per person (95% CI, 0.0088 to 0.0314). The corresponding ICERs were $52,000 per life-year gained (95% CI, 34,000 to 106,000) and $81,000 per QALY gained (95% CI, 52,000 to 186,000). However, the ICERs varied widely in subgroup and sensitivity analyses. We estimated that screening for lung cancer with low-dose CT would cost $81,000 per QALY gained, but we also determined that modest changes in our assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.)