Literature review: the economic costs of lung disease and the cost effectiveness of policy and service interventions
A report, conducted by York Health Economics Consortium (YHEC) on behalf of the British Lung Foundation (BLF) & British Thoracic Society (BTS), has identified published evidence on the economic costs of lung disease and the cost-effectiveness of different NHS activities, programmes and campaigns to combat lung problems.
SInce the report was published, we have been asked to draw readers' attention to some recently published evidence of cost effectiveness of Low Radiation Computed Tomography for Lung Cancer. This follows.
Health Economics of Low Radiation Dose Computed Tomography Screening for Lung Cancer
The most direct analysis of cost effectiveness comes from analysis of the National Lung Cancer Screening trial. This showed that in this trial the ICER per QALY gain was $81,000 (£60,520) per QALY gained (95% CI, 52,000 to 186,000). However, this was strongly influenced by the risk profile of the people screened and fell to $42,000 (£31,381) for the highest 40%. There are a number of other reports that have modelled cost effectiveness, with widely differing results. Noteworthy is the improvement in cost effectiveness where smoking cessation rates are increased by CT screening, something reported in the UK Lung Screen trial. Relevant to the UK, where healthcare costs are considerably less than the US, the UKLS trial found that the ICER was £8466 per QALY gained (95% CI, £5542 to £12 569) . This did not include the reduction in smoking. Recently, microsimulation modelling has been used to investigate the most cost-effective screening programmes in Canada, using Canadian healthcare costs. This was able to identify an optimum scenario with a cost of 41,000 CAD (£23,673.) . However, this became more favourable if the cost of a LDCT was halved and this would approximate to the cost in the UK (cost in Canada 430 CAD, = £250; CT cost in UK £140). Thus, relevant direct analyses emphasise the need to limit screening to the high-risk group to control costs. Modelling can be used to select programmes on the basis of limits that apply in the UK.
($ conversion Dec 2017)
1. Black WC, Gareen IF, Soneji SS, Sicks JD, Keeler EB, Aberle DR, Naeim A, Church TR, Silvestri GA, Gorelick J, et al: Cost-effectiveness of CT screening in the National Lung Screening Trial.N Engl J Med 2014, 371:1793-1802.
2. Brain K, Carter B, Lifford KJ, Burke O, Devaraj A, Baldwin DR, Duffy S, Field JK: Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial.Thorax 2017.
3. Field JK, Duffy SW, Baldwin DR, Brain KE, Devaraj A, Eisen T, Green BA, Holemans JA, Kavanagh T, Kerr KM, et al: The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer.Health Technol Assess 2016, 20:1-146.
4. Ten Haaf K, Tammemagi MC, Bondy SJ, van der Aalst CM, Gu S, McGregor SE, Nicholas G, de Koning HJ, Paszat LF: Performance and Cost-Effectiveness of Computed Tomography Lung Cancer Screening Scenarios in a Population-Based Setting: A Microsimulation Modeling Analysis in Ontario, Canada.PLoS Med 2017, 14:e1002225.