@Article{info:doi/10.2196/36425,
author="Zhao, Zixuan
and Du, Lingbin
and Li, Yuanyuan
and Wang, Le
and Wang, Youqing
and Yang, Yi
and Dong, Hengjin",
title="Cost-Effectiveness of Lung Cancer Screening Using Low-Dose Computed Tomography Based on Start Age and Interval in China: Modeling Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="6",
volume="8",
number="7",
pages="e36425",
keywords="cost-effectiveness analysis; low-dose computed tomography; screening; lung cancer; China",
abstract="Background: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in China. The effectiveness of screening for lung cancer has been reported to reduce lung cancer--specific and overall mortality, although the cost-effectiveness, optimal start age, and screening interval remain unclear. Objective: This study aimed to assess the cost-effectiveness of lung cancer screening among heavy smokers in China by incorporating start age and screening interval. Methods: A Markov state-transition model was used to assess the cost-effectiveness of a lung cancer screening program in China. The evaluated screening strategies were based on a screening start age of 50-74 years and a screening interval of once or annually. Transition probabilities were obtained from the literature and validated, while cost parameters were derived from databases of local medical insurance bureaus. A societal perspective was adopted. The outputs of the model included costs, quality-adjusted life years (QALYs), and lung cancer--specific mortality, with future costs and outcomes discounted by 5{\%}. A currency exchange rate of 1 CNY=0.1557 USD is applicable. The incremental cost-effectiveness ratio (ICER) was calculated for different screening strategies relative to nonscreening. Results: The proposed model suggested that screening led to a gain of 0.001-0.042 QALYs per person as compared with the findings in the nonscreening cohort. Meanwhile, one-time and annual screenings were associated with reductions in lung cancer--related mortality of 0.004{\%}-1.171{\%} and 6.189{\%}-15.819{\%}, respectively. The ICER ranged from 119,974.08 to 614,167.75 CNY per QALY gained relative to nonscreening. Using the World Health Organization threshold of 212,676 CNY per QALY gained, annual screening from a start age of 55 years and one-time screening from the age of 65 years can be considered as cost-effective in China. Deterministic and probabilistic sensitivity analyses were conducted. Conclusions: This economic evaluation revealed that a population-based lung cancer screening program in China for heavy smokers using low-dose computed tomography was cost-effective for annual screening of smokers aged 55-74 years and one-time screening of those aged 65-74 years. Moreover, annual lung cancer screening should be promoted in China to realize the benefits of a guideline-recommended screening program. ",
issn="2369-2960",
doi="10.2196/36425",
url="https://publichealth.jmir.org/2022/7/e36425",
url="https://doi.org/10.2196/36425",
url="http://www.ncbi.nlm.nih.gov/pubmed/35793127"
}