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Cost Effectiveness of CT Screening in the National Lung Screening Trial

Cost Effectiveness of CT Screening in the National Lung Screening Trial. William C. Black, M.D. Dartmouth-Hitchcock Medical Center NLST CEA Writing Team. Writing Team. Methods Base case results Subset & sensitivity analyses Limitations. Outline. Comparison: LDCT, CXR, No Screen

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Cost Effectiveness of CT Screening in the National Lung Screening Trial

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  1. Cost Effectiveness of CT Screening in theNational Lung Screening Trial William C. Black, M.D. Dartmouth-Hitchcock Medical Center NLST CEA Writing Team

  2. Writing Team

  3. Methods Base case results Subset & sensitivity analyses Limitations Outline

  4. Comparison: LDCT, CXR, No Screen Health effects: LYs and QALYs Costs: $US (reference 2009) Perspective: Societal Time horizon: Within-trial and lifetime Discount rate: 3% Cost Effectiveness Analysis Gold et al. Cost-effectiveness in health and medicine. 1996.

  5. Study Population

  6. Study Population

  7. Aggregate LYs from entry to death Observed survival thru12/31/2009 Projected survival after 12/31/2009 age, sex, smoking, lung ca stage Health Effects (LYs)

  8. Adjust LYs for QOL SF-6D utility scoring (0-1.0) Estimate missing scores age, sex, lung ca stage Health Effects (QALYs) Brazier et al. JHE 2002; 21:271-92

  9. Direct medical - screening, workup, treatment Non-medical - travel, lost wages Costs

  10. Utilization based on medical abstraction Costs from utilization & Medicare prices Missing costs imputed using trial-wide variables – arm, scr result, lung ca, etc Direct Medical Costs

  11. Bootstrap confidence intervals Subset analyses Sensitivity analyses Eff’ness CXR, # catch up cases, costs Uncertainty

  12. LDCT screening affects only lung cancer CXR screening has no effect No remaining catch up lung cancers. Base Case Assumptions

  13. Base Case Results

  14. Base Case Results

  15. Bootstrap CIs 10,000 iterations

  16. Subset Analysis

  17. Subset Analysis

  18. CXR vs No Screening

  19. Catch up in CXR arm

  20. Impact of Positive Screen

  21. Impact of Stage IA NSCLC

  22. Cost of LDCT

  23. Number of FU CTs

  24. Cost of Incidental Findings

  25. Relative Risk of Lung Cancer

  26. LIMITATIONS • Other effects of LDCT screening • Survival Stage IA NCSLC • Imprecision of QOL instruments • Cost of screening process

  27. SUMMARY • NLST LDCT Scr≈ _ • Some uncertainty within NLST • Much uncertainty outside NLST • Opportunity to improve on NLST

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