PURPOSE: An autoantibody test (AABT) has been recently developed as an aid to early detection of lung cancer in high-risk patients. While less sensitive than computed tomography (CT), it can detect smaller, less advanced cancers and has greater specificity than CT. The cost-effectiveness of screening for lung cancer using AABT is unknown.
METHODS: Assuming effectiveness of screening a high-risk population with CT, we developed a model depicting the consequences of screening high-risk patients - a single time - a hypothetical cohort of 100,000 high-risk screening-naïve patients (mean age, 60 years) for lung cancer using AABT followed by CT if positive (AABT->CT) and AABT plus CT (AABT+CT) for all patients, vs CT alone and vs no screening. Non-small-cell lung cancer (NSCLC)--indolent and aggressive types--and small-cell lung cancer (SCLC) were considered. Sensitivity and specificity of AABT (price=$300) were assumed to be 40% and 90%; for CT (price=$301), corresponding estimates were calculated to be, from a "prevalence-screen" perspective using data from the Mayo Clinic screening study, 47% and 49%. Cancers detected with AABT were assumed, on average, to be smaller and less advanced. Cost-effectiveness was calculated as the ratio of the difference in expected costs (2008US$) to the difference in quality-adjusted life-years (QALYs) for AABT->CT and AABT+CT, vs CT alone and vs no screening.
RESULTS: A total of 2901 of the 100,000 high-risk persons would be expected to have undiagnosed aggressive NSCLC or SCLC. True-positives would total: 1161 with AABT->CT, 1979 with AABT+CT, and 1363 with CT; corresponding false-positives would total 9623 (AABT->CT), 53,794 (AABT+CT), and 49,079 (CT).
CONCLUSION: Screening high-risk patients for lung cancer using AABT, in conjunction with CT, is likely to be cost-effective by current standards in comparison with screening with CT alone or no screening.
CLINICAL IMPLICATIONS: If a physician decides to screen high-risk individuals for lung cancer, an AABT may offer an additional aid to early detection.
DISCLOSURE: Peter Boyle, Grant monies (from industry related sources) Work conducted by PAI was funded by Oncimmune Ltd.; No Product/Research Disclosure Information