COST-EFFECTIVENESS OF A NATIONAL LOW-DOSE COMPUTED TOMOGRAPHY (LDCT) LUNG CANCER SCREENING PROGRAM IN IRAQ: ECONOMIC EVALUATION USING LOCAL ADAPTATION OF GLOBAL MODELS
Author(s)
Tahseen Alrubai, MD1, Hayder Rbeea, MD1, Manwar Alnaqash, MD1, Sura Abd, MD1, Saifaddin Mahdi Mousa, PharmD2, Mohanad Aydin, PharmD3, Dania Jalaa, PharmD4, Omar Hussein, MD5.
1Iraqi Ministry of health, Baghdad, Iraq, 2Market Access, AstraZeneca, Baghdad, Iraq, 3Market Access, AstraZeneca Iraq, Baghdad, Iraq, 4Medical Affairs, AstraZeneca Iraq, Baghdad, Iraq, 5Evidence Generation, AstraZeneca Near East and Maghreb, Cairo, Egypt.
1Iraqi Ministry of health, Baghdad, Iraq, 2Market Access, AstraZeneca, Baghdad, Iraq, 3Market Access, AstraZeneca Iraq, Baghdad, Iraq, 4Medical Affairs, AstraZeneca Iraq, Baghdad, Iraq, 5Evidence Generation, AstraZeneca Near East and Maghreb, Cairo, Egypt.
OBJECTIVES: To evaluate the clinical and economic impact of implementing a national LDCT lung cancer screening program for high-risk adults in Iraq, using country-adapted NELSON and NLST trial methodologies.
METHODS: A Markov cost-effectiveness model, originally developed for the UK, was adapted to the Iraqi healthcare context. Local epidemiological and demographic inputs—such as smoking prevalence, lung cancer incidence, stage distribution, survival rates, and direct/indirect costs—were obtained from Iraqi registries, literature, and validated by interviews with key opinion leaders. The analysis included public payer and societal perspectives, considering direct medical costs (screening, diagnostics, treatment per cancer stage) and indirect costs (productivity loss, transportation). Outcomes included incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), quality-adjusted life-years (QALYs), life years (LYs), and reductions in lung cancer mortality. Model robustness was assessed by scenario and one-way sensitivity analyses. The time horizon was set at 42 years, with 3% discount rate.
RESULTS: Under the NELSON protocol, LDCT screening in Iraq produced an ICER of IQD 3.9 million per QALY gained—well below the national willingness-to-pay threshold (IQD 23.9 million/QALY)—and yielded 103,932 additional QALYs and 137,318 life years gained, with a net monetary benefit over IQD 960 billion. The NLST protocol resulted in higher ICERs (IQD 13.6 million/QALY; NMB: IQD 351 billion) but remained highly cost-effective. Screening shifted detection toward early cancers (stage I: 62% with screening vs. 16% without), reduced late-stage presentation, and averted up to 4,466 deaths (NELSON). Sensitivity analyses identified lung cancer incidence as the major driver of cost-effectiveness.
CONCLUSIONS: A national LDCT lung cancer screening program for high-risk adults in Iraq is highly cost-effective, providing substantial health and economic benefits. NELSON-type volumetric screening protocols maximize value by reducing false positives and late-stage costs. These findings strongly support policy action to implement and scale nationwide LDCT screening in Iraq, with systematic local data collection recommended to refine program effectiveness.
METHODS: A Markov cost-effectiveness model, originally developed for the UK, was adapted to the Iraqi healthcare context. Local epidemiological and demographic inputs—such as smoking prevalence, lung cancer incidence, stage distribution, survival rates, and direct/indirect costs—were obtained from Iraqi registries, literature, and validated by interviews with key opinion leaders. The analysis included public payer and societal perspectives, considering direct medical costs (screening, diagnostics, treatment per cancer stage) and indirect costs (productivity loss, transportation). Outcomes included incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), quality-adjusted life-years (QALYs), life years (LYs), and reductions in lung cancer mortality. Model robustness was assessed by scenario and one-way sensitivity analyses. The time horizon was set at 42 years, with 3% discount rate.
RESULTS: Under the NELSON protocol, LDCT screening in Iraq produced an ICER of IQD 3.9 million per QALY gained—well below the national willingness-to-pay threshold (IQD 23.9 million/QALY)—and yielded 103,932 additional QALYs and 137,318 life years gained, with a net monetary benefit over IQD 960 billion. The NLST protocol resulted in higher ICERs (IQD 13.6 million/QALY; NMB: IQD 351 billion) but remained highly cost-effective. Screening shifted detection toward early cancers (stage I: 62% with screening vs. 16% without), reduced late-stage presentation, and averted up to 4,466 deaths (NELSON). Sensitivity analyses identified lung cancer incidence as the major driver of cost-effectiveness.
CONCLUSIONS: A national LDCT lung cancer screening program for high-risk adults in Iraq is highly cost-effective, providing substantial health and economic benefits. NELSON-type volumetric screening protocols maximize value by reducing false positives and late-stage costs. These findings strongly support policy action to implement and scale nationwide LDCT screening in Iraq, with systematic local data collection recommended to refine program effectiveness.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE394
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Disease
Oncology