Tanner J. Caverly, MD, MPH; Pianpian Cao, MPH; Rodney A. Hayward, MD; Rafael Meza, PhD
An earlier version of this work was presented in abstract form at the 2016 Society of General Internal Medicine Annual Meeting, Hollywood, Florida, 11–14 May 2016, and at the 2016 Society for Medical Decision Making Annual Meeting, Vancouver, British Columbia, Canada, 23–26 October 2016.
Disclaimer: Drs. Caverly and Hayward were employees of the U.S. Department of Veterans Affairs at the time this study was conducted. The views expressed are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the U.S. government.
Grant Support: Development of the provider-facing Web tool that uses the results of this study was supported by a grant from the Veterans Affairs Quality Enhancement Research Initiative (QUE 15-286). Ms. Cao and Dr. Meza were supported by National Cancer Institute grant U01CA199284.
Disclosures: Dr. Caverly reports a grant from the Genentech Corporate Giving Scientific Project Support Program 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=M17-2561.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive 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 and statistical code: Not available. Data set: Available from the National Cancer Institute Cancer Data Access System (https://biometry.nci.nih.gov/cdas/nlst).
Corresponding Author: Tanner J. Caverly, MD, MPH, VA Center for Clinical Management Research and University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 331W, Ann Arbor, MI 48109; e-mail, email@example.com.
Current Author Addresses: Dr. Caverly: VA Center for Clinical Management Research and University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 331W, Ann Arbor, MI 48109.
Ms. Cao: School of Public Health, University of Michigan, M5336 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
Dr. Hayward: VA Center for Clinical Management Research and University of Michigan Medical School, 2800 Plymouth Road, Building 10, Room G016-4A, Ann Arbor, MI 48109-2800.
Dr. Meza: School of Public Health, University of Michigan, M5533 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
Author Contributions: Conception and design: T.J. Caverly, R.A. Hayward, R. Meza.
Analysis and interpretation of the data: T.J. Caverly, P. Cao, R.A. Hayward, R. Meza.
Drafting of the article: T.J. Caverly, P. Cao.
Critical revision of the article for important intellectual content: T.J. Caverly, P. Cao, R.A. Hayward, R. Meza.
Final approval of the article: T.J. Caverly, P. Cao, R.A. Hayward, R. Meza.
Provision of study materials or patients: T.J. Caverly.
Statistical expertise: T.J. Caverly, P. Cao, R.A. Hayward, R. Meza.
Administrative, technical, or logistic support: P. Cao.
Collection and assembly of data: T.J. Caverly.
Many health systems are exploring how to implement low-dose computed tomography (LDCT) screening programs that are effective and patient-centered.
To examine factors that influence when LDCT screening is preference-sensitive.
State-transition microsimulation model.
Two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry.
U.S.-representative sample of simulated patients meeting current U.S. Preventive Services Task Force criteria for screening eligibility.
LDCT screening annually for 3 years.
Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, disutilities (the “degree of dislike”) quantifying the burden of screening and follow-up were varied across a likely range. The effect of varying the rate of false-positive screening results and overdiagnosis associated with screening was also examined.
Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides.
Rates of false-positive findings and overdiagnosed lung cancer were not highly influential.
The quantitative thresholds that were identified may vary depending on the structure of the microsimulation model.
Identifying circumstances in which LDCT screening is more versus less preference-sensitive may help clinicians personalize their screening discussions, tailoring to both preferences and clinical benefit.
Caverly TJ, Cao P, Hayward RA, Meza R. Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study. Ann Intern Med. [Epub ahead of print 29 May 2018]169:1–9. doi: 10.7326/M17-2561
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Published: Ann Intern Med. 2018;169(1):1-9.
Published at www.annals.org on 29 May 2018
Cancer Screening/Prevention, Hematology/Oncology, High Value Care, Lung Cancer, Prevention/Screening.
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