Cost-effectiveness of low-dose CT screening for lung cancer in a European country with high prevalence of smoking-A modelling study
Cost-effectiveness of low-dose CT screening for lung cancer in a European country with high prevalence of smoking-A modelling study
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DOI：
10.1016/j.lungcan.2018.05.008
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发表时间：
2018-07-01
期刊：
影响因子：
5.3
通讯作者：
Puhan, Milo A.
中科院分区：
文献类型：
--
作者：
Tomonaga, Yuki;ten Haaf, Kevin;Puhan, Milo A.
目的：在欧洲，低剂量计算机断层扫描筛查肺癌的潜在效果和成本效益以及北美研究结果的适用性尚不确定。我们的目的是评估在瑞士吸烟率较高的人口环境中肺癌筛查的效果和成本效益。材料和方法：使用有关肺癌流行病学、吸烟行为和治疗成本的国家特定输入参数，对微模拟筛查分析-肺 (MISCAN) 模型进行了调整。在 1935 年至 1965 年间出生的队列中，从公共医疗保健系统的角度对 648 种筛查方案（具有不同筛查开始和停止年龄、吸烟资格标准和筛查间隔）的影响和成本进行了终生检查。 结果：所有筛查方案均显示发现的肺癌病例总数有所增加，肺癌死亡率有所下降。在效率前沿，27 种情景中有 15 种显示每增加一个生命年增量成本效益比低于 50,000。这些情况使肺癌死亡率降低了 6-15%，同时使肺癌诊断发生率增加了 2-6%。结论：这些结果表明，在瑞士这个高收入、吸烟率高的欧洲国家，肺癌筛查可能具有成本效益。
Objectives: In Europe, there is uncertainty about the potential effects and cost-effectiveness of low dose computed tomography screening for lung cancer and about the applicability of results of North American studies. We aimed to estimate the effects and cost-effectiveness of lung cancer screening in a population-based setting in Switzerland where the smoking prevalence is high.Materials and methods: The Mlcrosimulation Screening ANalysis-Lung (MISCAN) model was adapted using country specific input parameters regarding lung cancer epidemiology, smoking behaviours, and treatment costs. The effects and costs of 648 screening scenarios with different screening start and stop ages, smoking eligibility criteria, and screening intervals were examined from a public healthcare system perspective across a lifetime horizon in a cohort born between 1935 and 1965.Results: All screening scenarios showed an increase in the total number of detected lung cancer cases and a decrease in lung cancer mortality. On the efficiency frontier, 15 of 27 scenarios showed incremental cost-effectiveness ratios below 50,000 per life year gained. These scenarios reduced lung cancer mortality by 6-15% while increasing incidence of lung cancer diagnoses by 2-6%.Conclusion: These results suggest that lung cancer screening may be cost-effective in Switzerland, a high-income, European country with high smoking prevalence.