Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Abstract

Introduction: The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands. Methods: A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted. Results: Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs. Conclusions: Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.