Economic Evaluation of Lung Cancer Screening With Low-Dose Computed Tomography in Brazil

OBJECTIVES: This study aimed to estimate the cost-effectiveness of lung cancer (LC) screening with low-dose computed tomography (LDCT) for high-risk individuals in Brazil.

METHODS: The cost-effectiveness analysis was conducted by comparing two LDCT screening strategies (annual or biannual) and not screening from the perspective of the Brazilian unified health system. A cohort of heavy smokers (20 pack-years) were screened from age 50 until 70 years old. The modeling approach consisted of a decision tree combined with a state-transition Markov model. The decision tree estimated in each screening round, the number of LC cases diagnosed and the associated costs, based on LDCT accuracy. The Markov model estimated costs and health outcomes accrued throughout the lifetime of individuals with LC according to the cancer stage at diagnosis. Only direct medical costs were included related to screening, diagnosis, and treatment. The outcomes were measured in life-years gained (LYGs). A 5% annual discount rate was applied to costs and outcomes. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: In the baseline scenario, compared with no screening, annual and biennial strategies were considered cost-effective according to the Brazilian cost-effectiveness threshold of U$ 19,090.00 per LYG. Incremental cost-effectiveness rates (ICER) were U$ 17,742.45/LYG and U$ 10,298.58/LYG for annual and biennial screening, respectively. In probabilistic sensitivity analysis, screening was cost-effective in 94.2% of the simulations for the biennial and 52% for the yearly strategies. The ICER was more sensitive to assumptions regarding LC incidence as the other most relevant parameters (screening sensitivity for LC or stage I/II detection) had no impact on the final results.

CONCLUSIONS: The LDCT screening for early detection of lung cancer in high-risk individuals could be cost-effective in Brazil. The results suggest that screening every two years should be the preferred strategy. Further analysis of different target populations and screening strategies could contribute to better informing policymakers.