Steven D. Criss, BS; Pianpian Cao, MPH; Mehrad Bastani, PhD; Kevin ten Haaf, PhD; Yufan Chen, MPH; Deirdre F. Sheehan, MPH; Erik F. Blom, MD; Iakovos Toumazis, PhD; Jihyoun Jeon, PhD; Harry J. de Koning, MD, PhD; Sylvia K. Plevritis, PhD; Rafael Meza, PhD; Chung Yin Kong, PhD
Acknowledgment: The authors thank E.J. Feuer for scientific input and critical review of the work.
Grant Support: This study is based on research conducted by the NCI's CISNET (NCI grant U01-CA199284).
Disclosures: Dr. ten Haaf reports nonfinancial support from the International Association for the Study of Lung Cancer Strategic Screening Advisory Committee, grants from Sunnybrook Health Sciences (Toronto, Canada) and the University of Zurich, and grants and nonfinancial support from the NELSON screening program outside the submitted work. Ms. Sheehan reports grants from the NCI during the conduct of the study. Dr. Blom reports grants from National Institutes of Health (NIH)/NCI during the conduct of the study and grants and nonfinancial support from the NELSON screening program outside the submitted work. Dr. de Koning reports grants from the NIH during the conduct of the study and was a principal investigator for NELSON. Dr. Plevritis reports grants from the NCI during the conduct of the study and has been a scientific consultant to Grail. Dr. Meza reports grants from the NIH during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0322.
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. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Model details are available in Table 1; additional details may be found on the CISNET Web site (https://cisnet.cancer.gov/lung/profiles.html). Statistical code: An earlier version of the SHG is available by request (e-mail, shg-distrib@lung.cisnet-group.org). Data set: Smoking prevalence, initiation, cessation, and intensity rates are available in the publications listed under “Smoking History Generator” at https://resources.cisnet.cancer.gov/projects/#.
Corresponding Author: Chung Yin Kong, PhD, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Suite 1010, Boston, MA 02114; e-mail, joey@mgh-ita.org.
Current Author Addresses: Mr. Criss and Mr. Chen: Massachusetts General Hospital, 101 Merrimac Street, Suite 1010, Boston, MA 02114.
Ms. Cao and Drs. Jeon and Meza: University of Michigan School of Public Health, 1415 Washington Heights, SPH-II 5533, Ann Arbor, MI 48109.
Drs. Bastani, Toumazis, and Plevritis: Stanford University, 318 Campus Drive, S255, Stanford, CA 94305.
Drs. ten Haaf, Blom, and de Koning: Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Ms. Sheehan: Broad Institute, 415 Main Street, Cambridge, MA 02142.
Dr. Kong: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Suite 1010, Boston, MA 02114.
Author Contributions: Conception and design: S.D. Criss, M. Bastani, I. Toumazis, S.K. Plevritis, R. Meza, C.Y. Kong.
Analysis and interpretation of the data: S.D. Criss, P. Cao, M. Bastani, K. ten Haaf, Y. Chen, D.F. Sheehan, E.F. Blom, I. Toumazis, J. Jeon, H.J. de Koning, S.K. Plevritis, R. Meza, C.Y. Kong.
Drafting of the article: S.D. Criss, D.F. Sheehan, R. Meza, C.Y. Kong.
Critical revision for important intellectual content: S.D. Criss, K. ten Haaf, E.F. Blom, H.J. de Koning, S.K. Plevritis, R. Meza, C.Y. Kong.
Final approval of the article: S.D. Criss, P. Cao, M. Bastani, K. ten Haaf, Y. Chen, D.F. Sheehan, E.F. Blom, I. Toumazis, J. Jeon, H.J. de Koning, S.K. Plevritis, R. Meza, C.Y. Kong.
Provision of study materials or patients: S.D. Criss, S.K. Plevritis, C.Y. Kong.
Statistical expertise: M. Bastani, K. ten Haaf, Y. Chen, H.J. de Koning, S.K. Plevritis, R. Meza, C.Y. Kong.
Obtaining of funding: H.J. de Koning, S.K. Plevritis, R. Meza, C.Y. Kong.
Administrative, technical, or logistic support: S.D. Criss, R. Meza, C.Y. Kong.
Collection and assembly of data: S.D. Criss, K. ten Haaf, D.F. Sheehan, I. Toumazis, R. Meza, C.Y. Kong.
Recommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST).
To compare the cost-effectiveness of different stopping ages for lung cancer screening.
By using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT).
The NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses' Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator.
Current, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort.
45 years.
Health care sector.
Annual LDCT according to NLST, CMS, and USPSTF criteria.
Incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).
The 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates.
Probabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%).
Scenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data.
All 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective.
CISNET (Cancer Intervention and Surveillance Modeling Network) Lung Group, National Cancer Institute.
Criss SD, Cao P, Bastani M, et al. Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study. Ann Intern Med. 2019;171:796–804. [Epub ahead of print 5 November 2019]. doi: https://doi.org/10.7326/M19-0322
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© 2020
Published: Ann Intern Med. 2019;171(11):796-804.
DOI: 10.7326/M19-0322
Published at www.annals.org on 5 November 2019
Cancer Screening/Prevention, Healthcare Delivery and Policy, Hematology/Oncology, High Value Care, Lung Cancer.
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