Cost-effectiveness of computed tomography screening for lung cancer in the United States.
Cost-effectiveness of computed tomography screening for lung cancer in the United States.
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DOI：
10.1097/jto.0b013e31822e59b3
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Gazelle GS
中科院分区：
文献类型：
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作者：
McMahon PM;Kong CY;Bouzan C;Weinstein MC;Cipriano LE;Tramontano AC;Johnson BE;Weeks JC;Gazelle GS
一项随机试验表明，肺癌筛查可降低死亡率。识别影响筛查成本效益的参与者和项目特征将有助于将试验结果转化为人群水平的益处。在现有的患者水平肺癌模型中模拟了六个美国队列（50岁、60岁或70岁的男性和女性）。吸烟史反映了观察到的美国模式。我们在每个场景中模拟了每个队列中50万个相同个体的一生史。每质量调整生命年获得的成本（$/QALY）估计为每个程序：CT筛查，独立戒烟治疗（4-30% 1年戒烟），和联合方案。与不进行筛查和假设背景戒烟率相比，50-74岁的当前和既往吸烟者的年度筛查费用在126，000 - 169，000美元/QALY（最低20包-年吸烟）或110，000 - 166，000美元/QALY（最低40包-年）之间。筛查是有益的，但当模型包括辐射诱发的肺癌时，每个QALY的成本更高。如果筛查参与使背景戒烟率加倍，则每年筛查的费用（50岁，20包-年最低）低于75，000美元/QALY。如果屏幕参与减半背景退出率，从筛选的好处几乎被抹去。如果筛查对戒烟率没有影响，那么每年筛查的费用要比每年戒烟治疗的费用高，但提供的戒烟次数要少。与每年单独戒烟相比，50岁时每年联合筛查/戒烟治疗计划的费用为130，500 - 159，700美元/QALY。CT筛查的成本效益可能与可实现的戒烟率密切相关。试验和进一步的建模应该探索吸烟行为和屏幕参与之间的关系的后果。
A randomized trial has demonstrated that lung cancer screening reduces mortality. Identifying participant and program characteristics that influence the cost-effectiveness of screening will help translate trial results into benefits at the population level. Six U.S. cohorts (males and females aged 50, 60, or 70) were simulated in an existing patient-level lung cancer model. Smoking histories reflected observed U.S. patterns. We simulated lifetime histories of 500,000 identical individuals per cohort in each scenario. Costs per quality-adjusted life-year gained ($/QALY) were estimated for each program: CT screening; stand-alone smoking cessation therapies (4–30% 1-year abstinence); and combined programs. Annual screening of current and former smokers aged 50–74 cost between $126,000–$169,000/QALY (minimum 20 pack-years of smoking) or $110,000–$166,000/QALY (40 pack-year minimum), compared to no screening and assuming background quit rates. Screening was beneficial but had a higher cost per QALY when the model included radiation-induced lung cancers. If screen participation doubled background quit rates, the cost of annual screening (at age 50, 20 pack-year minimum) was below $75,000/QALY. If screen participation halved background quit rates, benefits from screening were nearly erased. If screening had no effect on quit rates, annual screening cost more but provided fewer QALYs than annual cessation therapies. Annual combined screening/cessation therapy programs at age 50 cost $130,500–$159,700/QALY, compared to annual stand-alone cessation. The cost-effectiveness of CT screening will likely be strongly linked to achievable smoking cessation rates. Trials and further modeling should explore the consequences of relationships between smoking behaviors and screen participation.