New research reveals that a low-dose CT lung-screening program for an at-risk population can be cost effective, while saving lives.
The study, published in the Nov. 6 issue of the New England Journal of Medicine, used data from the National Lung Screening Trial (NLST) to determine that screening for lung cancer would cost $81,000 per each year of quality life gained--well below the generally accepted $100,000-per-year threshold.
"While it sounds like an awful lot, $100,000 to $150,000 per quality-adjusted life-year is considered a reasonable value within the United States," study author William Black, a professor of radiology at the Dartmouth University Institute for Health Policy and Clinical Practice, told HealthDay News. "It's plausible to design a screening program for lung cancer that ultimately would be cost-effective."
While the study demonstrated the cost-effectiveness of CT lung screening, that cost-effectiveness depends on a number of assumptions. For example, according to an announcement from Brown University, in coming up with the $81,000 ratio, the authors made the assumption that screening would provide no further medical benefit other than lung cancer detection. However, when they factored in the possibility that other serious conditions could be discovered and treated as a result of screening, the ratio fell to $54,000 per quality-adjusted life-year added.
However, the ratio becomes less favorable when other assumptions are made, such as adding in the future health costs for survivors, assuming higher costs than in the study for screening, follow-up, or treatment, or more pessimistic assumptions about survival or quality of life. And when the authors operated under the assumption that the cost of the screening exam could reach $500 (as opposed to the $285 it cost during the NLST), the cost-effectiveness ratio eroded further.
"There are additional questions that still need to be investigated," study co-author Ilana Gareen, assistant professor of epidemiology at Brown University's School of Public Health, said. "Issues such as how often patients need to be screened, what's the optimal interval, whether screen results should impact future screening frequency--i.e., should you wait two years to screen again after a patient has a negative screening exam?" The authors concluded that ultimately, healthcare providers will have the most impact on how cost-effective screening will be in what is a complex healthcare marketplace.
In a study presented last year at a meeting of National Cancer Institute's Board of Scientific Advisors and the National Cancer Advisory Board Black reported that low-dose CT--compared to two other screening strategies--produced the highest number of quality adjusted life years with an incremental cost effectiveness of about $73,000.
To learn more:
- see the study in the New England Journal of Medicine
- see the announcement from Brown University
- read the article in HealthDay News