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    MTE09 - Cost Effectiveness of CT Screening (ID 53)

    • Event: WCLC 2013
    • Type: Meet the Expert (ticketed session)
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      MTE09.1 - Cost Effectiveness of CT Screening (ID 602)

      07:00 - 08:00  |  Author(s): C. Berg

      • Abstract
      • Presentation
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      Abstract
      Background The National Lung Screening Trial (NLST) demonstrated that screening with low-dose CT compared to screening with chest radiography reduced lung cancer mortality. Several cost-effectiveness analyses of lung cancer screening have been performed and will be reviewed in the presentation. A team of investigators from the NLST developed detailed data collection instruments to prospectively collect information about the entire screening process and cost expenditures while the trial was ongoing with the specific intention of performing a cost-effectiveness analysis after conclusion of the study. The team has concluded this research and now reports the cost-effectiveness of CT screening within the setting of the NLST. Methods Mean life-years, quality-adjusted life-years (QALYs), and mean costs per person and incremental cost effectiveness ratios for three alternative screening strategies using the societal perspective were estimated. CT screening was compared to chest radiographic and no screening, assuming that chest radiographic screening was ineffective and only contributed costs directly related to screening, not lung cancer treatment. Life-years were based on all observed deaths within the trial and projected survival of those alive at the end. Quality adjustments were derived from a subset of participants selected for quality of life surveys. Costs were based on utilization rates, derived from a subset of participants selected for medical record abstraction, and Medicare reimbursements. Life-years, QALYs, and costs were discounted at 3% per year. Uncertainty was assessed using bootstrap sampling of participants, subset analyses based on age, gender, smoking history, and lung cancer risk, and one-way sensitivity analyses on several assumptions. Results In the base case, the CXR screening strategy was dominated. Compared to no screening, CT screening costs $1441 per person and provided an additional 0.0217 QALYs per person; the incremental cost effectiveness ratio was $67,000 per QALY gained. Conclusions CT screening for lung cancer as performed in the NLST appears to be cost effective under a wide range of assumptions. Whether screening outside the trial will be cost effective will depend on who is selected for screening, how screening is performed, and how screenees are subsequently managed. As the United States Preventive Services Task Force has given a draft recommendation of “B” for lung cancer screening, it will need to be covered without a deductible by insurance companies upon implementation of the Patient Protection and Affordable Care Act. Therefore, appropriate implementation of screening is critical. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.)

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