Economic evaluation of low-dose computed tomography for lung cancer screening among high-risk individuals - evidence from Hungary based on the HUNCHEST-II study.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Lung Neoplasms*/diagnostic imaging ; Lung Neoplasms*/diagnosis ; Cost-Benefit Analysis* ; Early Detection of Cancer*/economics ; Early Detection of Cancer*/methods ; Tomography, X-Ray Computed*/economics ; Tomography, X-Ray Computed*/methods ; Quality-Adjusted Life Years*; Humans ; Hungary ; Middle Aged ; Aged ; Male ; Female ; Radiation Dosage
    • Abstract:
      Background: Lung cancer (LC) is the leading cause of cancer-related death in Hungary. Early diagnosis of LC contributes to delivering survival benefits to patients. Low-dose computer tomography (LDCT) is an imaging technology that can be used to identify smaller nodules. The aim of this study was to investigate the cost-effectiveness of introducing organised LDCT screening in Hungary among individuals aged 50 to 74 years with high-risk for developing LC using clinical effectiveness and resource utilisation inputs based on the recent HUNCHEST-II clinical trial.
      Methods: We estimated costs and outcomes in a cost-utility analysis framework over the time horizon of 30 years to compare annual and biennial screening for LC with LDCT against standard screening. The economic evaluation simulated a cohort of current and former smokers aged 50 to 74 years with a smoking exposure of at least 25 pack-years, using data from HUNCHEST-II, a multicentre study to evaluate the impact of LDCT screening on early detection of LC. Complementary data were retrieved from published studies and interviews with local experts.
      Results: The results of the analysis are favourable from an economic perspective: the introduction of biennial screening for LC with LDCT yielded an incremental effectiveness of 0.031 QALYs as well as an increase in costs of 306 764 HUFs over the 30-year -time horizon when compared to standard screening. The value of the base case ICER (9 908 100 HUF/QALY) of biennial screening for LC with LDCT over standard screening was below the relevant cost-effectiveness threshold. Applying an annual screening strategy using LDCT yielded even more favourable cost-effectiveness results (ICER = 7 927 455 HUF/QALY) compared to biennial screening. Notably, the cost-effectiveness of biennial screening was extendedly dominated by annual screening.
      Conclusions: Along with the mature data on its effectiveness, our analysis confirms that using LDCT for LC screening among high-risk individuals is a cost-effective alternative of standard screening in Hungary. Funding a nationwide lung screening program that uses LDCT is a justified decision in economic terms; annual screening would be the optimal strategy to maximize health benefits; however in case of limited financial resources, biennial LDCT screening could offer a cost saving alternative for marginally less health gains than annual screening.
      Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
      (© 2024. The Author(s).)
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    • Contributed Indexing:
      Keywords: Cost-effectiveness analysis; Low-dose computed tomography; Lung cancer; Respiratory-gated imaging techniques; Smokers
    • Publication Date:
      Date Created: 20241203 Date Completed: 20241204 Latest Revision: 20241212
    • Publication Date:
      20241212
    • Accession Number:
      PMC11616101
    • Accession Number:
      10.1186/s12913-024-11828-w
    • Accession Number:
      39627793