PURPOSE: To evaluate the estimated cost-effectiveness, based on the cost per five-year lung cancer survivor, of a proactive screening program vs. symptom detection strategies in a representative subset of the United States population. Second, to report the total cost and survival results estimated for these two lung cancer management strategies.
METHODS: Estimations were computed based on the most recent five years of data available, extending from 1999 through 2003, within the thirteen Surveillance, Epidemiology, and End Results registries. The design framework of our model allowed for the incorporation of multiple values taken from the epidemiological and clinical literature to be utilized for cost inputs, scope of patients screened, diagnostic staging, and survival percentages. This enabled the analysis of over 700 scenarios, each containing a unique set of input values, for which the estimated cost per five-year survivor was compared between the symptom-detected and proactive screening approaches.
RESULTS: The estimated costs per five-year survivor were higher for the symptom-detected approach in all 729 scenarios analyzed, ranging from approximately $16,900 to $142,700 increased cost per five-year survivor. The estimated total number of five-year survivors and total costs were higher for the proactive screening method for all 729 scenarios, ranging from approximately 32,000 to 90,600 increased five-year survivors and $2.8B to $13.8B in increased total costs for the population studied.
CONCLUSION: The predicted increase in long term survival with annual computed tomography screening, and better utilization of healthcare dollars in terms of cost per five-year survivor are critically important considerations in directing effective future lung cancer management strategy.
CLINICAL IMPLICATIONS: Recent studies demonstrating increased detection of early stage lung cancer by annual computed tomography screening have sparked continued debate on the cost-effectiveness of such programs, with widely variant results reported. To date, no evaluation of cost effectiveness in terms of the cost per long-term survivor has been reported. Our analytical model offers an innovative tool providing insights into the continuing debate on the wisdom and advisability of implementing state and/or nationwide screening programs.
DISCLOSURE: Anthony Castleberry, No Financial Disclosure Information; No Product/Research Disclosure Information