COST-EFFECTIVENESS OF VOLUME-BASED LOW-DOSE CT LUNG CANCER SCREENING IN A HIGH-RISK POPULATION IN MOROCCO: A COHORT SIMULATION INFORMED BY THE NELSON STUDY
Author(s)
Fatima Wafqui, MSc, MD1, Sihame LKHOYAALI, MD, PhD2, Saber Boutayeb, MD, PhD1, Mohamed Khalis, PhD1, Nejwa Lamrani, PharmD3, Ahmed HADAOUI, PharmD4.
1Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco, 2Medical Oncology, National Institute of Oncology (INO), Ibn Sina University Hospital, Rabat, Morocco, 3Market Access, AstraZeneca Morocco, Casablanca, Morocco, 4Evidence Generation, AstraZeneca Near East and Maghreb, Cairo, Egypt.
1Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco, 2Medical Oncology, National Institute of Oncology (INO), Ibn Sina University Hospital, Rabat, Morocco, 3Market Access, AstraZeneca Morocco, Casablanca, Morocco, 4Evidence Generation, AstraZeneca Near East and Maghreb, Cairo, Egypt.
OBJECTIVES: Lung cancer is a leading cause of cancer mortality in Morocco, where most cases are diagnosed at advanced stages due to the absence of a national screening programme. This study evaluated the cost-effectiveness of volume-based low-dose computed tomography (CT) lung cancer screening (LCS) versus no screening for in a high-risk population in Morocco.
METHODS: A cost-effectiveness analysis compared 17 annual rounds LCS with volume CT versus no screening in adults aged 50-74 with significant smoking history, from a Moroccan payer perspective over a lifetime horizon. A decision tree modelled NELSON’s study outcomes, while a state-transition Markov model simulated treatment costs and long-term survival per stage at diagnosis. Model inputs were informed by the Grand Casablanca Cancer Registry, National Reference Pricing (TNR), Moroccan epidemiological data, and 10 key opinion leaders interviews. A screening uptake rate of 30% yielded 292,568 participants. Costs and health outcomes were discounted at 3.5%. Deterministic, probabilistic, and scenario sensitivity analyses were performed.
RESULTS: LCS shifted 75% of diagnoses to stage I (versus 3% without screening), reducing stage IV diagnoses by 91%. Over a lifetime horizon, screening averted 7,083 premature lung cancer deaths, generated 342,505 additional quality-adjusted life years (QALYs) and 476,824 life-years gained. The incremental cost-effectiveness ratio (ICER) was MAD 18,189/QALY (USD 2,001/QALY), well below the estimated willingness-to-pay threshold (WTP) of MAD 108,898/QALY (3×GDP per capita). Probabilistic sensitivity analysis confirmed robustness, with 97% of simulations falling below the threshold. Findings remained cost-effective under conservative uptake assumptions (10% and 20%).
CONCLUSIONS: Annual volume-based low-dose CT LCS for high-risk adults maybe highly cost-effective in Morocco, with an estimated ICER far below the estimated national willingness-to-pay threshold. Policymakers can consider these findings as foundational economic evidence supporting implementation of a national LCS program to reduce lung cancer mortality through earlier detection.
METHODS: A cost-effectiveness analysis compared 17 annual rounds LCS with volume CT versus no screening in adults aged 50-74 with significant smoking history, from a Moroccan payer perspective over a lifetime horizon. A decision tree modelled NELSON’s study outcomes, while a state-transition Markov model simulated treatment costs and long-term survival per stage at diagnosis. Model inputs were informed by the Grand Casablanca Cancer Registry, National Reference Pricing (TNR), Moroccan epidemiological data, and 10 key opinion leaders interviews. A screening uptake rate of 30% yielded 292,568 participants. Costs and health outcomes were discounted at 3.5%. Deterministic, probabilistic, and scenario sensitivity analyses were performed.
RESULTS: LCS shifted 75% of diagnoses to stage I (versus 3% without screening), reducing stage IV diagnoses by 91%. Over a lifetime horizon, screening averted 7,083 premature lung cancer deaths, generated 342,505 additional quality-adjusted life years (QALYs) and 476,824 life-years gained. The incremental cost-effectiveness ratio (ICER) was MAD 18,189/QALY (USD 2,001/QALY), well below the estimated willingness-to-pay threshold (WTP) of MAD 108,898/QALY (3×GDP per capita). Probabilistic sensitivity analysis confirmed robustness, with 97% of simulations falling below the threshold. Findings remained cost-effective under conservative uptake assumptions (10% and 20%).
CONCLUSIONS: Annual volume-based low-dose CT LCS for high-risk adults maybe highly cost-effective in Morocco, with an estimated ICER far below the estimated national willingness-to-pay threshold. Policymakers can consider these findings as foundational economic evidence supporting implementation of a national LCS program to reduce lung cancer mortality through earlier detection.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
P23
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Trial-Based Economic Evaluation
Disease
Oncology