JMIR Publications

ABSTRACT

Background:

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths in China. The effectiveness of screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness and the optimal age as well as screening interval remained unclear.

Objective:

This study aimed to assess cost-effectiveness of lung cancer screening for heavy smokers in China incorporating start age and screening interval.

Methods:

A Markov state-transition model was built to assess the cost-effectiveness of lung cancer screening programs in China. The evaluated screening strategies consisted of different start age (50;55;60;65;70 years old) and the interval of screening (one-time or annual). Effectiveness values were obtained through literature review, and cost parameters were derived from databases of local medical insurance bureau. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs) and lung cancer specific mortality reduction, with future costs and outcomes discounted by 5%. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to non-screening.

Results:

In the base case, our model suggested the screening cohort led to an increase of 0.001 to 0.042 QALY gained per person compared to non-screening cohort. Meanwhile, the one-time screening cohort and annual screening cohort were associated with a reduction in lung cancer mortality ranged from 0.004% to 1.171% and from 6.189% to 15.819%, respectively. The ICER was ranging from CNY119,974.08 to CNY614,167.75 per QALY gained relative to non-screening. Using a World Health Organization (WHO) threshold of CNY 212,676 per QALY gained, annual screening from 55 years old and one-time screening from 65 years old can be considered as cost-effective in Chinese context. Deterministic and probabilistic sensitivity analyses were conducted.

Conclusions:

We provide evidence that a population-based lung cancer screening program in China for heavy smokers using LDCT was cost-effective in certain conditions. Moreover, efforts should be prompted to promote annual lung cancer screening program in China in order to realize the benefits of the guidelines-recommended screening program. Clinical Trial: not applicable