Cancer Res Treat.  2022 Jul;54(3):728-736. 10.4143/crt.2021.480.

Cost Utility Analysis of a Pilot Study for the Korean Lung Cancer Screening Project

• Kim J
• Cho B
• Kim SH
• Choi CM
• Kim Y
• Jo MW

• KMID: 2531319
• DOI: http://doi.org/10.4143/crt.2021.480

Abstract

Purpose
The aim of this study was to evaluate the cost utility of a pilot study of Korean Lung Cancer Screening Project.
Materials and Methods
We constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55-74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate.
Results
The base case (US$25,383 per quality-adjusted life year gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution.
Conclusion
Our results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.

Keyword

Cost-benefit analysis; Lung neoplasms; Mass screening; Markov chains

Figure

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  Fig. 1 Markov model of lung cancer screening.

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  Fig. 2 Cost utility efficiency frontier. S, Scenario; S0, No screening; S1, age 55–79, S2, age 55–89; S3, age 55–99; S4, age 60–74; S5, age 65–74. Base case, S1, and S5 were excluded due to extended dominance.

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  Fig. 3 Sensitivity analyses, tornado diagram of ICUR. ICUR, incremental cost-utility ratio; S, Scenario; S6, reduction of positive rates (age 55–57, −20%; age ≥ 58, −50%); S7, distribution of SEER summary stages (localized, TNM Ia; regional, TNM Ib–IIIa; distant, TNM IIIb–IV); S8, distribution of SEER summary stages by age group (age 55–59: localized 100.0%, regional 0.0%, distant 0.0%; age 60–69: localized 57.1%, regional 28.6%, distant 14.3%; age 70–79: localized 33.3%, regional 50.0%, distant 16.7%).

Reference

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