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Canada's lung cancer screening program appears cost-effective
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Annual lung cancer screening using low-dose CT scans appeared cost-effective when used within the Canadian health care system, according to study results.
Further, an adjunct smoking cessation program may further cost savings and improve the smoking quit rate.
“Lung cancer kills more Canadians than breast, colorectal and prostate cancers combined and conferred a substantial burden of suffering on patients and their families, as well as cost to the health care system,” John R. Goffin, MD, FRCPC, associate professor of medical oncology at McMaster University in Hamilton, Ontario, and colleagues wrote. “The number of lung cancer cases is expected to continue to rise in keeping with population growth and aging.”
Results of the U.S. National Lung Cancer Screening Trial (NLST) support annual screening for lung cancer among smokers using low-dose computed tomographic (LDCT) scans (National Lung Screening Trial Research Team, et al. N Engl J Med. 2011;doi: 10.1056/NEJMoa1102873). However, the cost-effectiveness of screening in a publicly funded health care system remained uncertain.
Goffin and colleagues studied the cost-effectiveness of LDCT-scan screening for lung cancer within the Canadian health care system, which is publicly funded. They used the Canadian Partnership Against Cancer’s Cancer Risk Management Model (CRMM) to simulate individual lives within the Canadian population between 2014 and 2034, incorporating cancer risk, disease management, outcome and cost data.
The researchers modeled smokers and former smokers based on eligibility for screening in the NLST, which included a 30 pack-year smoking history and age 55 to 74 years. The reference screening scenario assumed annual scans up to age 75 years, 60% participation by 10 years, 70% screening adherence and unchanged smoking rates.
The researchers aggregated CRMM outputs and discounted costs (in 2008 Canadian dollars) and life-years by 3% annually.
The incremental cost-effectiveness ratio (ICER) of screening served as the primary endpoint.
Compared with no screening, the reference screening scenario saved 51,000 quality-adjusted life-years (QALY) and had an ICER of $52,000 per QALY.
Further, modeling for 20 pack-years resulted in an ICER of $62,000, whereas modeling for 20 pack-years had a $43,000 ICER.
Changes in participation rates altered life-years saved but not the incremental cost-effectiveness ratio. However, the incremental cost-effectiveness ratio demonstrated sensitivity to changes in adherence. A 20% drop in adherence decreased the incremental cost of the program and had an ICER of $40,000 per QALY.
The researchers also recommended the creation of an adjunct smoking cessation program, which could improve the quit rate by 22.5%, resulting in a reduction of the ICER to $24,000 per QALY.
The researchers acknowledged limitations of their study, including their failure to incorporate the costs related to the initiation of a screening program into their model. Further, the model did not simulate the underlying disease biology of lung cancer, since lung cancer disease progression is not well established.
“In considering implementation of a screening program, decision makers will need to evaluate multiple factors that could affect both the QALYs saved and the cost and cost effectiveness of the program,” Goffin and colleagues concluded. “Our simulations using the CRMM provide inputs to this decision-making. Policymakers can use the CRMM to determine impacts for their own jurisdiction and, importantly, estimate the effect on budget and incremental resource needs necessary to mount an LDCT lung cancer screening program.” – by Cameron Kelsall
Disclosure: The Canadian Partnership Against Cancer funded the study. Goffin reports grants from the Canadian Partnership Against Cancer and an advisory board position with Amgen. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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