Vaibhav Kumar, MD; Joshua T. Cohen, PhD; David van Klaveren, PhD; Djøra I. Soeteman, PhD; John B. Wong, MD; Peter J. Neumann, ScD; David M. Kent, MD, MS
Acknowledgment: The authors thank Christine Lundquist, Tara Lavelle, David Kim, and Robin Ruthazer (Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts) for their contributions.
Disclosures: Dr. Cohen reports grants from the Bill and Melinda Gates Foundation and the National Institutes of Health (NIH) during the conduct of the study; grants from the National Pharmaceutical Council, Pharmaceutical Research Manufacturers of America, Amgen, Biogen, GE Healthcare, Genentech, Gilead, Janssen, Merck, Novartis, Otsuka, Pfizer, Purdue Pharma, Sanofi, and Vertex outside the submitted work; and personal fees from Lundbeck and Precision Health Economics outside the submitted work. Dr. Wong reports grants from the Agency for Healthcare Research and Quality and the NIH during the conduct of the study and personal fees from the American College of Physicians, Cambridge University Press, and Wolters Kluwer outside the submitted work. Dr. Neumann reports consulting or advisory fees from Merck, Bayer, Pacira, Novo Nordisk, Shire, Amgen, the Congressional Budget Office, Boston Health Economics, Vertex, Precision Health Economics, and the CEA Registry Sponsors outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1401.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available by request from Dr. Kent (e-mail, firstname.lastname@example.org). Data set: Available from the National Cancer Institute Cancer Data Access System (www.biometry.nci.nih.gov/cdas/nlst).
Requests for Single Reprints: David M. Kent, MD, MS, Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box 063, Boston, MA 02111; e-mail, email@example.com.
Current Author Addresses: Drs. Kumar, Cohen, Neumann, and Kent: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box 063, Boston, MA 02111.
Dr. van Klaveren: Department of Medical Statistics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
Dr. Soeteman: Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115.
Dr. Wong: Tufts Medical Center, 800 Washington Street, #302, Boston, MA 02111.
Author Contributions: Conception and design: D.I. Soeteman, J.B. Wong, D.M. Kent.
Analysis and interpretation of the data: V. Kumar, D. van Klaveren, D.I. Soeteman, J.B. Wong, P.J. Neumann, D.M. Kent.
Drafting of the article: V. Kumar, J.T. Cohen, J.B. Wong, P.J. Neumann, D.M. Kent.
Critical revision for important intellectual content: V. Kumar, J.T. Cohen, D. van Klaveren, D.I. Soeteman, J.B. Wong, D.M. Kent.
Final approval of the article: V. Kumar, J.T. Cohen, D. van Klaveren, D.I. Soeteman, J.B. Wong, P.J. Neumann, D.M. Kent.
Statistical expertise: D. van Klaveren, J.B. Wong.
Obtaining of funding: J.B. Wong, D.M. Kent.
Administrative, technical, or logistic support: J.B. Wong. D.M. Kent
Collection and assembly of data: V. Kumar, D. van Klaveren, D.I. Soeteman, J.B. Wong.
Targeting low-dose computed tomography (LDCT) for lung cancer screening to persons at highest risk for lung cancer mortality has been suggested to improve screening efficiency.
To quantify the value of risk-targeted selection for lung cancer screening compared with National Lung Screening Trial (NLST) eligibility criteria.
Cost-effectiveness analysis using a multistate prediction model.
Current and former smokers eligible for lung cancer screening.
Health care sector.
Risk-targeted versus NLST-based screening.
Incremental 7-year mortality, life expectancy, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of screening with LDCT versus chest radiography at each decile of lung cancer mortality risk.
Participants at greater risk for lung cancer mortality were older and had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits during the first 7 years ranged from 1.2 to 9.5 lung cancer deaths prevented per 10 000 person-years for the lowest to highest risk deciles, respectively (extreme decile ratio, 7.9). The gradient of benefits across risk groups, however, was attenuated in terms of life-years (extreme decile ratio, 3.6) and QALYs (extreme decile ratio, 2.4). The incremental cost-effectiveness ratios (ICERs) were similar across risk deciles ($75 000 per QALY in the lowest risk decile to $53 000 per QALY in the highest risk decile). Payers willing to pay $100 000 per QALY would pay for LDCT screening for all decile groups.
Alternative assumptions did not substantially alter our findings.
Our model did not account for all correlated differences between lung cancer mortality risk and quality of life.
Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are attenuated and modest in terms of life-years, QALYs, and cost-effectiveness.
National Institutes of Health (U01NS086294).
Kumar V, Cohen JT, van Klaveren D, Soeteman DI, Wong JB, Neumann PJ, et al. Risk-Targeted Lung Cancer Screening: A Cost-Effectiveness Analysis. Ann Intern Med. [Epub ahead of print 2 January 2018]:. doi: 10.7326/M17-1401
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Published: Ann Intern Med. 2018.
Cancer Screening/Prevention, Hematology/Oncology, Lung Cancer, Prevention/Screening, Pulmonary/Critical Care.
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