COST-UTILITY ANALYSIS OF A NATIONAL LOW-DOSE COMPUTED TOMOGRAPHY (LDCT) LUNG CANCER SCREENING PROGRAM IN JORDAN: A MARKOV SIMULATION STUDY
Author(s)
Mahmoud AbuAwad, MD,JBGS, Eman Hammad, PhD.
Department of Health Economics and Healthcare Administration, Public Health Institute, University of Jordan, Amman, Jordan.
Department of Health Economics and Healthcare Administration, Public Health Institute, University of Jordan, Amman, Jordan.
OBJECTIVES: Lung cancer is the leading cause of cancer mortality in Jordan, with most cases diagnosed at advanced stages due to the absence of early detection programs. While evidence from major international trials (NLST, NELSON) confirms that LDCT screening reduces lung cancer mortality by 20 24%, no national cost-utility analysis has yet assessed its value for Jordan s health system.
This Project aims to evaluate the cost-utility of implementing an annual LDCT lung cancer screening program for high-risk adults in Jordan compared with no screening, using local epidemiological, clinical, and cost data from the public-sector perspective.
METHODS: A state-transition (Markov) model was developed to simulate lung cancer progression and outcomes over a 25-year time horizon. The target population includes adults aged 55 74 with ≥30 pack-year smoking history who quit ≤15 years ago. Model inputs were derived from Jordan Cancer Registry, Jordan Adult Tobacco Survey 2025, GLOBOCAN 2022, and published meta-analyses. Health outcomes were expressed in quality-adjusted life years (QALYs) using Jordan s EQ-5D-3L value set. Both costs and utilities were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses (1,000 Monte Carlo iterations) explored uncertainty. Cost-effectiveness was assessed against Jordan s willingness-to-pay (WTP) threshold of 3,000 9,000 JOD/QALY.
RESULTS: Preliminary base-case results indicate an incremental cost-effectiveness ratio (ICER) of ≈144,000 JOD/QALY for annual LDCT versus no screening. The ICER was most sensitive to LDCT unit cost, adherence, and stage-specific treatment costs. Probabilistic analysis suggests <10% probability of cost-effectiveness at the current WTP threshold.
CONCLUSIONS: Under current cost and adherence assumptions, national LDCT screening in Jordan is not cost-effective. However, integrating smoking cessation interventions, optimizing eligibility criteria, and negotiating imaging costs could substantially improve value for money and inform HTA-based policy decisions.
This Project aims to evaluate the cost-utility of implementing an annual LDCT lung cancer screening program for high-risk adults in Jordan compared with no screening, using local epidemiological, clinical, and cost data from the public-sector perspective.
METHODS: A state-transition (Markov) model was developed to simulate lung cancer progression and outcomes over a 25-year time horizon. The target population includes adults aged 55 74 with ≥30 pack-year smoking history who quit ≤15 years ago. Model inputs were derived from Jordan Cancer Registry, Jordan Adult Tobacco Survey 2025, GLOBOCAN 2022, and published meta-analyses. Health outcomes were expressed in quality-adjusted life years (QALYs) using Jordan s EQ-5D-3L value set. Both costs and utilities were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses (1,000 Monte Carlo iterations) explored uncertainty. Cost-effectiveness was assessed against Jordan s willingness-to-pay (WTP) threshold of 3,000 9,000 JOD/QALY.
RESULTS: Preliminary base-case results indicate an incremental cost-effectiveness ratio (ICER) of ≈144,000 JOD/QALY for annual LDCT versus no screening. The ICER was most sensitive to LDCT unit cost, adherence, and stage-specific treatment costs. Probabilistic analysis suggests <10% probability of cost-effectiveness at the current WTP threshold.
CONCLUSIONS: Under current cost and adherence assumptions, national LDCT screening in Jordan is not cost-effective. However, integrating smoking cessation interventions, optimizing eligibility criteria, and negotiating imaging costs could substantially improve value for money and inform HTA-based policy decisions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE367
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Surgery