COST-EFFECTIVENESS MODELS OF LUNG CANCER SCREENING BY LDCT IN EUROPE FROM 2015 TO 2026: A SYSTEMATIC REVIEW AND METHODOLOGICAL ASSESSMENT ADAPTED FOR FRANCE
Author(s)
Lucie Simon, MSc1, Sébastien Couraud, MD, PhD, Prof2, Emmanuel Grolleau, MD2, FRANCOIS-EMERY COTTE, MA, MPH, PharmD, PhD3, Isabelle Durand-Zaleski, MPP, PhD, MD4.
1Université Lyon 1, Inserm U1290 Research on Healthcare Performance (RESHAPE) ; Bristol Myers Squibb, Rueil-Malmaison, France, 2Hospices Civils de Lyon, Lyon, France, 3Bristol Myers Squibb, Rueil-Malmaison, France, 4Assistance Publique Hopitaux de Paris URCEco, Paris, France.
1Université Lyon 1, Inserm U1290 Research on Healthcare Performance (RESHAPE) ; Bristol Myers Squibb, Rueil-Malmaison, France, 2Hospices Civils de Lyon, Lyon, France, 3Bristol Myers Squibb, Rueil-Malmaison, France, 4Assistance Publique Hopitaux de Paris URCEco, Paris, France.
OBJECTIVES: Lung cancer is the leading cause of cancer-related mortality, largely driven by late-stage diagnosis. Low-Dose Computed Tomography (LDCT) screening in high-risk populations significantly reduces mortality and is recommended in Europe. In France, the IMPULSION program is the first national initiative evaluating screening in heavy smokers aged 50-74. We conducted a systematic literature review of cost-effectiveness models assessing LDCT-based lung cancer screening in European settings, alongside a methodological assessment of modelling choices and cost components most relevant for adaptation to the French context.
METHODS: A systematic search (PubMed, Embase, Cochrane) combined terms related to lung cancer screening, LDCT and health economic modelling, restricted to Jan2015-Mar2026. Eligible studies were original cost-effectiveness or cost-utility models using LDCT-screening as the intervention within a European country setting. Extracted data covered population characteristics, model structure, perspective, cost categories, effectiveness outcomes and ICERs.
RESULTS: In total, 21 studies met the inclusion criteria. They spanned 14 countries, mainly the Netherlands (n=4), the UK, Italy, Hungary and France (n=2 each). Target populations were typically defined from prior trials, notably NELSON (n=10) and NLST (n=2). Model structures were predominantly decision-trees associated to Markov (n=8), Markov alone (n=5) and microsimulation (n=4). The perspective was payer/healthcare system (n=19) or societal (n=2). Cost components varied widely: presence of recruitment costs (n=14), implementation/organizational costs (n=5) and heterogeneous diagnostic procedure costs. LDCT-scan cost was always included, but not interpretation, technical costs or specialist consultation (n=10). Only 14 models included novel treatments (immunotherapies/TKIs). Follow-up, incidental findings and overdiagnosis costs/utilities were frequently omitted. ICERs ranged €2,345-€50,000/QALY gained (median=€11,487). Sensitivity analyses identified screening costs, stage-I cancer utility and stage-IV treatment costs as key drivers.
CONCLUSIONS: These European analyses align broadly with populations eligible for the French program. Models predominantly combine decision-tree and Markov structures but show substantial heterogeneity in cost components, particularly implementation and organizational costs.
METHODS: A systematic search (PubMed, Embase, Cochrane) combined terms related to lung cancer screening, LDCT and health economic modelling, restricted to Jan2015-Mar2026. Eligible studies were original cost-effectiveness or cost-utility models using LDCT-screening as the intervention within a European country setting. Extracted data covered population characteristics, model structure, perspective, cost categories, effectiveness outcomes and ICERs.
RESULTS: In total, 21 studies met the inclusion criteria. They spanned 14 countries, mainly the Netherlands (n=4), the UK, Italy, Hungary and France (n=2 each). Target populations were typically defined from prior trials, notably NELSON (n=10) and NLST (n=2). Model structures were predominantly decision-trees associated to Markov (n=8), Markov alone (n=5) and microsimulation (n=4). The perspective was payer/healthcare system (n=19) or societal (n=2). Cost components varied widely: presence of recruitment costs (n=14), implementation/organizational costs (n=5) and heterogeneous diagnostic procedure costs. LDCT-scan cost was always included, but not interpretation, technical costs or specialist consultation (n=10). Only 14 models included novel treatments (immunotherapies/TKIs). Follow-up, incidental findings and overdiagnosis costs/utilities were frequently omitted. ICERs ranged €2,345-€50,000/QALY gained (median=€11,487). Sensitivity analyses identified screening costs, stage-I cancer utility and stage-IV treatment costs as key drivers.
CONCLUSIONS: These European analyses align broadly with populations eligible for the French program. Models predominantly combine decision-tree and Markov structures but show substantial heterogeneity in cost components, particularly implementation and organizational costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE388
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Disease
Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)