TY - JOUR
T1 - Targeted lung cancer screening in the age of immunotherapies and targeted therapies – an economic evaluation for Australia
AU - Roseleur, Jacqueline
AU - Karnon, Jonathan
AU - de Koning, Harry
AU - Milch, Vivienne
AU - Anderson, Katrina
AU - Real, Jacqui
AU - Keefe, Dorothy
AU - ten Haaf, Kevin
PY - 2024/12
Y1 - 2024/12
N2 - Background: The cost-effectiveness of different lung cancer screening strategies has been evaluated from an Australian public health system perspective using static models. In addition, the impact of novel therapies, including immunotherapies and targeted therapies, on the cost-effectiveness of lung cancer screening has not yet been evaluated comprehensively. We evaluated the benefits, harms and cost-effectiveness of a targeted national lung screening program in Australia, accounting for the increasing uptake of novel therapies, which informed the lung cancer screening recommendations of the Australian Medical Services Advisory Committee (MSAC). Methods: Australia-specific data on lung cancer epidemiology, smoking behaviour and care costs were used to adapt the MIcrosimulation SCreening ANalysis (MISCAN)-Lung model. Benefits, harms and cost-effectiveness of different targeted lung cancer screening scenarios were evaluated for individuals born between 1945 and 1969. The scenarios considered various screening age ranges, intervals and eligibility criteria (minimum accumulated smoking history and PLCOm2012 risk thresholds). Findings: The MSAC-recommended scenario was cost-effective at AUD62,754 per quality-adjusted life-year compared to no screening. This scenario biennially screens current and former smokers (quit ≤10 years ago) who smoked ≥30 pack-years between ages 50 and 70, preventing 62 lung cancer deaths per 100,000 and yielding 8.4 quality-adjusted life-years per prevented lung cancer death. Using novel therapies reduced the incremental costs of screening compared to no-screening by 14.8% but yielded 11.3% fewer incremental quality-adjusted life-years compared to traditional anti-cancer therapies, due to the improved survival yielded by novel therapies. Overall, the cost-effectiveness of screening was better when costs and effects of novel therapies were applied (AUD62,754 vs AUD65,340 per quality-adjusted life-year gained; 4% difference). Interpretation: Targeted lung cancer screening is more cost-effective when costs and effects of novel therapies are applied, although impacts on cost-effectiveness are likely to be marginal. Funding: Cancer Australia.
AB - Background: The cost-effectiveness of different lung cancer screening strategies has been evaluated from an Australian public health system perspective using static models. In addition, the impact of novel therapies, including immunotherapies and targeted therapies, on the cost-effectiveness of lung cancer screening has not yet been evaluated comprehensively. We evaluated the benefits, harms and cost-effectiveness of a targeted national lung screening program in Australia, accounting for the increasing uptake of novel therapies, which informed the lung cancer screening recommendations of the Australian Medical Services Advisory Committee (MSAC). Methods: Australia-specific data on lung cancer epidemiology, smoking behaviour and care costs were used to adapt the MIcrosimulation SCreening ANalysis (MISCAN)-Lung model. Benefits, harms and cost-effectiveness of different targeted lung cancer screening scenarios were evaluated for individuals born between 1945 and 1969. The scenarios considered various screening age ranges, intervals and eligibility criteria (minimum accumulated smoking history and PLCOm2012 risk thresholds). Findings: The MSAC-recommended scenario was cost-effective at AUD62,754 per quality-adjusted life-year compared to no screening. This scenario biennially screens current and former smokers (quit ≤10 years ago) who smoked ≥30 pack-years between ages 50 and 70, preventing 62 lung cancer deaths per 100,000 and yielding 8.4 quality-adjusted life-years per prevented lung cancer death. Using novel therapies reduced the incremental costs of screening compared to no-screening by 14.8% but yielded 11.3% fewer incremental quality-adjusted life-years compared to traditional anti-cancer therapies, due to the improved survival yielded by novel therapies. Overall, the cost-effectiveness of screening was better when costs and effects of novel therapies were applied (AUD62,754 vs AUD65,340 per quality-adjusted life-year gained; 4% difference). Interpretation: Targeted lung cancer screening is more cost-effective when costs and effects of novel therapies are applied, although impacts on cost-effectiveness are likely to be marginal. Funding: Cancer Australia.
KW - Australia
KW - Cost-effectiveness
KW - Immunotherapy
KW - Personalised lung cancer screening
KW - Population-based screening
UR - http://www.scopus.com/inward/record.url?scp=85209730071&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2024.101241
DO - 10.1016/j.lanwpc.2024.101241
M3 - Article
AN - SCOPUS:85209730071
SN - 2666-6065
VL - 53
JO - The Lancet Regional Health - Western Pacific
JF - The Lancet Regional Health - Western Pacific
M1 - 101241
ER -
