[HTML][HTML] Cost-effectiveness of CT screening in the National Lung Screening Trial

WC Black, IF Gareen, SS Soneji… - … England Journal of …, 2014 - Mass Medical Soc
WC Black, IF Gareen, SS Soneji, JRD Sicks, EB Keeler, DR Aberle, A Naeim, TR Church
New England Journal of Medicine, 2014Mass Medical Soc
Background The National Lung Screening Trial (NLST) showed that screening with low-
dose computed tomography (CT) as compared with chest radiography reduced lung-cancer
mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST.
Methods We 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 …
Background The National Lung Screening Trial (NLST) showed that screening with low-dose computed tomography (CT) as compared with chest radiography reduced lung-cancer mortality. We examined the cost-effectiveness of screening with low-dose CT in the NLST. Methods We 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. We 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. Results As compared with no screening, screening with low-dose CT cost an additional 1,631perperson(95%confidenceintervalCI,1,557to1,709)andprovidedanadditional0.0316life-yearsperperson(95%CI,0.0154to0.0478)and0.0201QALYsperperson(95%CI,0.0088to0.0314).ThecorrespondingICERswere 52,000 per life-year gained (95% CI, 34,000 to 106,000) and 81,000perQALYgained(95%CI,52,000to186,000).However,theICERsvariedwidelyinsubgroupandsensitivityanalyses.ConclusionsWeestimatedthatscreeningforlungcancerwithlow-doseCTwouldcost 81,000 per QALY gained, but we also determined that modest changes in our 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.(Funded by the National Cancer Institute; NLST ClinicalTrials. gov number, NCT00047385.)
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