Screening for lung cancer with CT - A preliminary cost-effectiveness analysis
Screening for lung cancer with CT - A preliminary cost-effectiveness analysis
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DOI：
10.1378/chest.121.5.1507
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发表时间：
2002-05-01
期刊：
影响因子：
9.6
通讯作者：
Clark, R
中科院分区：
文献类型：
--
作者：
Chirikos, TN;Hazelton, T;Clark, R
研究目的：评价CT肺癌筛查的潜在成本-效果。研究设计：估计两个假设性队列随着时间的推移而增加的成本-效果比。一个队列在研究期间的前5年进行了筛查；另一个队列接受了常规护理。根据备选参数/假设，从国家支付者群体的角度，为每一群人预测费用流。由于筛查和特定阶段治疗的差异，出现了队列费用差异。队列预期寿命也被预测，它们也因诊断时阶段分布的不同而不同。这些成本与预期寿命差异的比率被用来判断筛查的预期经济价值。结果：结果被分析为“最坏”的情况，即具有最高成本和最低收益率的假设。在这种情况下，如果筛查结果是50%的肺癌是在局部阶段发现的，那么CT筛查的成本约为每生命年48,000美元。在局限期发现的癌症比例越小，成本-效果比越高。结论：如果肺癌筛查有效，如果筛查过程能在局限期发现50%的癌症，那么很可能是划算的。
Study objective: To appraise the potential cost-effectiveness of lung cancer screening with CT.Study design: Incremental cost-effectiveness ratios are estimated for two hypothetical cohorts followed up over time. One cohort was screened over the first 5 years of the study period; the other cohort received usual care. Cost streams are projected for each cohort under alternative sets of parameters/assumptions and from the perspective of national payer groups. Cohort cost differentials arise as a result of screening and variations in stage-specific treatment. Cohort life expectancies are also projected, and they too differ as a consequence of variations in the stage distribution at diagnosis. The ratios of these cost and life-expectancy differences are used to judge the expected economic value of screening.Results: Results are analyzed for a "worst-case" scenario, ie, with the highest cost and lowest yield assumptions. Under these conditions, screening with CT costs approximately $48,000 per life-year gained, if screening results in 50% of lung cancers detected at localized stage. Smaller proportions of cancer detected at a localized stage result in higher cost-effectiveness ratios, and vice versa.Conclusion: If screening for lung cancer is effective, it is likely to be cost-effective if the screening process can detect > 50% of cancers at localized stage.