Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography: Comparing Hungarian Screening Protocols with the US NLST
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Model Development
2.2. Effectiveness Data and Model Inputs
2.3. Utility and ICER Calculation
2.4. Deterministic Sensitivity Analysis
2.5. Overdiagnosis
3. Results
3.1. Diagnosis Rate
3.2. ICER
3.3. Overdiagnosis
3.4. Deterministic Sensitivity Analysis
3.5. Stratified Analysis by Age
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Input Name | Hungarian Model N = 1860 | US Model N = 26,309 |
---|---|---|
First baseline screen—positive | 62 (3.33%) | 7191 (27.33%) |
First baseline screen—negative | 1531 (82.31%) | 19,118 (72.67%) |
First baseline screen—indeterminate | 267 (14.35%) | 0 (0.00%) 1 |
Negative first baseline screen—true negative | 591 (99.83%) 2 | 19,100 (99.91%) |
Negative first baseline screen—false negative | 1 (0.17%) | 18 (0.09%) |
Positive first baseline screen—true positive | 24 (48.98%) | 270 (3.75%) |
Positive first baseline screen—false positive | 25 (51.02%) | 6921 (96.25%) |
Indeterminant first baseline screen—positive repeat 3 | 13 (12.50%) | 0 (0.00%) 1 |
Input Name | Hungarian Model N = 682 | US Model N = 24,715 |
---|---|---|
First yearly screen—positive | 9 (1.25%) | 6904 (27.93%) |
First yearly screen—negative | 629 (92.17%) | 17,811 (72.07%) |
First yearly screen—indeterminate | 44 (6.58%) | 0 (0.00%) 1 |
Negative first yearly screen—true negative | 68 (99.90%) 2 | 17,801 (99.94%) |
Negative first yearly screen—false negative | 1 (0.10%) | 10 (0.06%) |
Positive first yearly screen—true positive | 4 (47.33%) | 168 (2.43%) |
Positive first yearly screen—false positive | 5 (52.67%) | 6736 (97.57%) |
Indeterminant first yearly screen—positive repeat 3 | 2 (8.33%) | 0 (0.00%) 1 |
Examination | Hungarian Model | US Model | Unit Cost (EUR) |
---|---|---|---|
Initial LDCT scan | 100% | 100% | 52.39 |
Abdominal CT | 39% | 3% | 83.43 |
Chest CT | 52% | 73% | 83.43 |
Bronchoscopy | 64% | 4% | 28.87 |
CT-guided thoracic biopsy | 27% | 2% | 77.90 |
Baseline | Year 1 | |||
---|---|---|---|---|
Age Band | Positive Rate | False-Positive Rate | Positive Rate | False-Positive Rate |
55–74 (reference) | 27.33% | 96.25% | 27.94% | 97.57% |
55–64 | 25.62% | 96.95% | 26.25% | 98.01% |
55–69 | 26.68% | 96.61% | 27.39% | 97.72% |
60–74 | 29.62% | 95.63% | 30.31% | 96.92% |
65–74 | 32.05% | 94.70% | 32.63% | 96.57% |
Model | Year 1 | Year 3 | Year 5 |
---|---|---|---|
Hungarian | 1.64% | 2.32% | 3.53% |
US | 1.71% | 2.38% | 3.61% |
Model | Treatment Cost (EUR) * | Screening Cost (EUR) ** | Total Cost (EUR) | QALY | ICER (EUR/QALY) |
---|---|---|---|---|---|
Hungarian | 2317 | 226 | 2543 | 6.996 | (Reference) |
US | 2375 | 211 | 2586 | 7.002 | 7875 |
Age Band | QALY | Δ QALY | Cost (EUR) | Δ Cost (EUR) | ICER (EUR/QALY) |
---|---|---|---|---|---|
55–74 (reference) | 7.00 | (Reference) | 2586 | (Reference) | (Reference) |
55–64 | 7.80 | 0.80 | 2413 | −173 | −215 * (dominates) |
55–69 | 7.48 | 0.48 | 2523 | −63 | −130 * (dominates) |
60–74 | 6.10 | −0.90 | 2729 | 143 | −159 ** (dominated) |
65–74 | 5.39 | −1.61 | 2736 | 150 | −93 ** (dominated) |
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Rajabi, T.; Szilberhorn, L.; Győrbíró, D.; Tatár, M.; Vokó, Z.; Nagy, B. Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography: Comparing Hungarian Screening Protocols with the US NLST. Cancers 2024, 16, 2933. https://doi.org/10.3390/cancers16172933
Rajabi T, Szilberhorn L, Győrbíró D, Tatár M, Vokó Z, Nagy B. Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography: Comparing Hungarian Screening Protocols with the US NLST. Cancers. 2024; 16(17):2933. https://doi.org/10.3390/cancers16172933
Chicago/Turabian StyleRajabi, Tanya, László Szilberhorn, Dávid Győrbíró, Manna Tatár, Zoltán Vokó, and Balázs Nagy. 2024. "Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography: Comparing Hungarian Screening Protocols with the US NLST" Cancers 16, no. 17: 2933. https://doi.org/10.3390/cancers16172933