Health Economic Evaluation of Lung Cancer Screening Using a Diagnostic Blood Test: The Early Detection of Cancer of the Lung Scotland (ECLS)

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear editors, dear authors,

I read the paper by McMeekin's group of authors with great interest. The paper takes up a relevant question for the first time and addresses the health economic issues surrounding a blood test for the early detection of lung cancer. The abstract is well written and summarises relevant aspects of the work. In the introduction, the paper introduces the current situation, data situation and problem definition. The only thing that remains unclear is the wording in the first sentence in the second half, where I would recommend a revision (with Scotland ... in Scotland). In my view, there should be something else at the end. The methods section describes the implementation and, above all, the model structure very well, so that this is comprehensible and reproducible. However, the question is whether, in addition to the other very successful flowcharts, a flowchart on inclusion would also improve understanding. The results section is comprehensive and uses graphs and tables to make the results comprehensible and easy to understand. The discussion also ties in with the level of these previous sections, so that the results are critically categorised and evaluated here. In summary, I recommend acceptance, taking into account the two small comments.

Author Response

Thank you for taking the time to review our manuscript and for your helpful suggestions.

Thank you for your suggestion, we have edited this sentence as follows:

‘Lung cancer (LC) has the highest mortality of cancers worldwide[1], with Scotland having one of the highest rates in the world; almost 4000 deaths in 2021.[2, 3]’

A flowchart for the pathway of inclusion of study participants was published elsewhere and available to the interested reader(1) (Figure 1), we hope that this is sufficient for Reviewer 1.

Reviewer 2 Report

Comments and Suggestions for Authors

Article of Health Economic evaluation of lung cancer screening using a diagnostic blood test.

The cost-effectiveness of a lung cancer screening intervention with diagnostic blood tests compared to “usual care” and “LDCT screening”.

The justification for the study is the surprise finding of the previous study, where more lung cancers were found in the non-screening arm compared to the screening arm.

The study is carried out using a modeling approach.

The article is very well written and done.

All sections meet their objectives: introduction, materials and methods, results, and discussion. The rationale and objectives of the study are well explained in the introduction. It is perfectly understandable how the study has been carried out, especially all the projections and simulations. The results are well presented and developed. In the discussion, it is reflected what the study brings again.

The reviewer is not a very expert in the modeling approach, but I find all the projections and simulations very coherent and sufficiently explained. All possible comments can be found in the limitations section or described in the work by the authors themselves.

The conclusions correlate with the results presented.

As a comment, we present a cost-effectiveness study for lung cancer screening. But I don't know about the studies done to prove the efficacy and effectiveness of blood markers for lung cancer. Cost-effectiveness studies presuppose that diagnostic methods are efficient and effective.

However, I believe that the study introduces some very interesting results and reflections that are of interest to the readers of the journal.

Author Response

Thank you for your comments, we appreciate the time you dedicated to reviewing our research and your kind comments.