CT Screening for Lung Cancer may be Cost-Effective

Black et al in their article published by the NEJM report that findings from the National Lung Screening Trial, that was funded by the NCI, showed that screening with low-dose computed tomography as compared with chest radiography reduced lung-cancer mortality.

Their research team estimated mean life-years, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratios (ICERs) for three alternative strategies: screening with low-dose CT, screening with radiography, and no screening. Estimations of life-years were based on the number of observed deaths that occurred during the trial and the projected survival of persons who were alive at the end of the trial. Quality adjustments were derived from a subgroup of participants who were selected to complete quality-of-life surveys. Costs were based on utilization rates and Medicare reimbursements. They also performed analyses of subgroups defined according to age, sex, smoking history, and risk of lung cancer and performed sensitivity analyses based on several assumptions.

As compared with no screening, screening with low-dose CT costs an additional $1,631 per person and provided an additional 0.0316 life-years per person and 0.0201 QALYs per person. The corresponding ICERs were $52,000 per life-year gained and $81,000 per QALY gained. However, the ICERs varied widely in subgroup and sensitivity analyses.

They concluded that screening for lung cancer with low-dose CT would cost $81,000 per QALY gained.  They also determined that modest changes in their assumptions would greatly alter this figure. The determination of whether screening outside the trial will be cost-effective will depend on how screening is implemented.

References

1.  Updating Cost-Effectiveness — The Curious Resilience of the $50,000-per-QALY Threshold.  Peter J. Neumann, Sc.D., et al N Engl J Med 2014; 371:796-797August 28, 2014  http://www.nejm.org/doi/full/10.1056/NEJMp1405158
2.  On November 11, 2014 the U.S. Centers for Medicare and Medicaid Services (CMS) approved CT lung cancer screening for Medicare recipients, saying the evidence is sufficient to justify screening high-risk individuals until the age of 74 years.