Analysis shows Europe-wide CT lung screening would save lives


A very first budget impact analysis of the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) model shows that it could prevent more than 18,000 premature deaths from lung cancer across Europe at a cost of 937 million euros if half of the eligible population were screened, according to a report.

Data published in 2020 from the NELSON trial showed that CT lung screening confers a significant reduction in lung cancer mortality in high-risk individuals (24% to 33%). Since then, discussions have focused on health economic evaluations of low-dose CT lung screening programs, according to the Dutch-led research group that presented the analysis at IASLC 2022.

Their study estimated financial impact and clinical outcomes using a budget impact model based on the results of the NELSON study for a CT lung screening program that would be rolled out in 28 European countries.

“We … developed a budget impact model to provide information on the absolute economic implications and clinical benefits,” said Xuanqi Pan, senior consultant in health economics and outcome research at the Institute. for DiagNostic Accuracy (iDNA) in the Netherlands. “We hope to drive home the idea that volume-based low-dose computed tomography is both clinically and economically effective for European countries, with substantial health and economic benefits for a reasonable budget. Governments can now plan the actual budget they need for the implementation of lung cancer screening, even gradually over time, because our model is flexible and also adapts to a screening participation rate that increases every year,” noted Pan who presented research at Sunday’s conference.

The NELSON study was a population-based controlled trial that recruited 15,792 people, who were randomized 1:1 to either the study arm or the control arm. Participants in the study arm were offered CT screenings at baseline, one, three, and five and a half years after randomization. No screening was offered to participants in the control arm.

Pan and his team applied their model based on the NELSON study to demonstrate the financial and health consequences of implementing a national lung cancer screening program in 28 European countries, compared to the current standard of care. (no screening). In the model, the eligible population meeting the NELSON inclusion criteria would undergo screening with volumetric nodule management. Results from the NELSON screening were also used in the model.

Clinical results and budgetary impact of lung cancer screening by volume computed tomography in Europe
Settings N (50% detection rate)
Screening population 20,997,108
Premature death from lung cancer avoided 18,169
Budget impact (annual) €937,321,529
Incremental costs per premature lung cancer averted €51,588
Incremental costs per screening participant 45 euros

The model assumes that the screening population would amount to nearly 21 million individuals, with 50% of eligible individuals being screened in Europe. With these assumptions, screening would prevent 18,169 premature deaths from lung cancer for a budgetary impact of 937.3 million euros.

The incremental cost per premature lung cancer death averted was €51,588, and the cost per screening participant was €45. Sensitivity analysis showed that the most influential parameters affecting the total budget impact were unit costs of CT scans, as well as treatment costs. Pan noted that the analysis did not include new technologies that could make screening more efficient, such as artificial intelligence (AI) or liquid biopsy diagnostic tests.

“Although every life is priceless, healthcare resources are limited, so maximizing gains on the available budget is key to maximizing the efficiency of healthcare systems,” noted Pan, who is a doctoral student. at the University of Groningen and studies the subject of health. economic evaluation of lung cancer screening.

In absolute numbers, the budget impact of implementing a CT scan lung cancer screening program provides additional information in addition to the cost-effectiveness analysis, she added, stating that it There are only a few studies reporting health expenditures for implementing screening, and these were conducted in the United States.

Xuanqi saucepan

Europe vs USA

Following the National Lung Screening Trial (NLST), a study indicated that CT screening would add $2 billion (1.97 billion euros) to annual national healthcare expenditure and prevent up to 8,100 premature deaths per lung cancer, at a detection rate of 75%. Another study estimated the costs of a widespread CT screening program at $2.5 billion (2.46 billion euros) at the same participation rate (75%) based on NLST screening results, a she noted.

“In our analysis, prevention of over 18,000 lung cancer deaths was achieved with a lower budget impact (approximately €937 million) in Europe, with 50% uptake. improved effectiveness of CT screening on NELSON screening outcomes and lower overall health care costs compared to the US, so comparing it to previous US studies, we believe it is reasonably priced , especially considering that it’s a cost-effective use of a country’s budget,” says Pan.

The budget impact in the Dutch study was calculated by comparing the total costs of implementing a lung screening program to a situation without screening. The premature deaths from lung cancer avoided were calculated by applying the reduction in mortality obtained in the NELSON study (24% for men and 33% for women during a 10-year follow-up); then the cost per premature death from lung cancer was calculated by dividing the total budgetary impact by the total number of premature deaths from lung cancer, which gives a figure of 51,588 euros. This compares to a 2012 calculation for the NLST of $240,081 (236,222 euros) at a 50% participation rate and $242,074 (238,183 euros) at a 75% participation rate.

A combination of several aspects explains the lower European budget, Pan noted, including different screening eligibility criteria, different lung cancer epidemiologies and the effectiveness of screening based on the nodule management protocol. NELSON has a volumetric approach with a lower false positive rate and lung cancer treatment costs, among others.

Next steps

Lung screening by volume CT scan has the potential to reduce the heavy disease burden of lung cancer – which caused 1.8 million deaths worldwide and nearly 400,000 deaths in Europe in 2020 – thanks to early detection, which then leads to reduced mortality in high-risk patients. populations. The researchers hope this study will help address lingering concerns about the economic implications of implementing national lung cancer screening programs.

The group also aims to adapt the budget impact model to other continents and is exploring the budget impact of using AI to aid in image reading for lung cancer screening programs, as Sensitivity analysis shows that a major driver of budget is CT unit cost and good AI can help reduce it. Modeling the impact of blood biomarkers is another promising direction for future research, Pan said.

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