COST-EFFECTIVENESS OF PUBLIC-FUNDED BIENNIAL LOW-DOSE CT LUNG CANCER SCREENING IN TAIWAN: A RISK-GROUP MARKOV ANALYSIS
Author(s)
Elise Chia Hui Tan, PhD1, Pei-Tsen Chen, MS1, Ching-Fen Shen, PhD2, Li-Ju Lin, PhD3, Pei-Chun Hsieh, MS3, Chi-Yen Huang, PhD3, Yu-Zu Ho, MBA3, Li-Lin Jheng, B.Des3.
1Department of Health Service and Administration, College of Public Health, China Medical University, Taiwan, Taichung, Taiwan, 2Health Promotion Administration, Ministry of Health and Welfare; Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Tainan, Taiwan, 3Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
1Department of Health Service and Administration, College of Public Health, China Medical University, Taiwan, Taichung, Taiwan, 2Health Promotion Administration, Ministry of Health and Welfare; Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Tainan, Taiwan, 3Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
OBJECTIVES: Never smokers, young women, and those with a family history are the high-risk population in East Asia. A national government-funded LDCT lung cancer screening program was launched in Taiwan in July 2022. Adults with a second-degree family history of lung cancer or heavy smokers with at least 20 pack-years are eligible. The aim of the study is to estimate the lifetime cost and effectiveness of the screening program.
METHODS: A real-world data-driven Markov cohort model was developed with a 1-year cycle length and a lifetime horizon. Baseline characteristics and screening performance were obtained from registry data on 150,461 participants (family history [FH] n=80,127, heavy smokers [HS] n=65,024, both criteria [FH/HS] n=5,310). Cost data were collected from the linked national LDCT registry, the National Health Insurance claims, and the Taiwan Cancer Registry. Willingness-to-pay (WTP) thresholds were three times GDP per capita in 2025. Uncertainty was examined by one-way deterministic analysis, 12 scenarios, and probabilistic sensitivity analysis with 10,000 iterations.
RESULTS: The biennial LDCT program reduced lung cancer mortality by 26.9% in the high-risk population with a family history or heavy smoking; 30.2% (Group HS), 18.4% (Group FH), and 37.9% (Group FH/HS); the number needed to screen was 139, 77,403, and 491, respectively. The ICER per QALY gained was €29,177. Additionally, Group HS had the lowest ICER at €10,765 per QALY gained, whereas ICERs were €85,664 for Group FH and €53,912 for Group FH/HS. When using 3x GDP per capita as the WTP threshold, the probability of the government-funded LDCT program was 100% for the overall high-risk population, 75.93% for Group FH, and 100% for Group HS.
CONCLUSIONS: Biennial LDCT screening remains cost-effective across all risk groups. Heavy smokers are the most cost-effective subgroup. The dual-criteria group shows the largest mortality reduction, at 37.9%, indicating an additive risk effect from the two exposures combined.
METHODS: A real-world data-driven Markov cohort model was developed with a 1-year cycle length and a lifetime horizon. Baseline characteristics and screening performance were obtained from registry data on 150,461 participants (family history [FH] n=80,127, heavy smokers [HS] n=65,024, both criteria [FH/HS] n=5,310). Cost data were collected from the linked national LDCT registry, the National Health Insurance claims, and the Taiwan Cancer Registry. Willingness-to-pay (WTP) thresholds were three times GDP per capita in 2025. Uncertainty was examined by one-way deterministic analysis, 12 scenarios, and probabilistic sensitivity analysis with 10,000 iterations.
RESULTS: The biennial LDCT program reduced lung cancer mortality by 26.9% in the high-risk population with a family history or heavy smoking; 30.2% (Group HS), 18.4% (Group FH), and 37.9% (Group FH/HS); the number needed to screen was 139, 77,403, and 491, respectively. The ICER per QALY gained was €29,177. Additionally, Group HS had the lowest ICER at €10,765 per QALY gained, whereas ICERs were €85,664 for Group FH and €53,912 for Group FH/HS. When using 3x GDP per capita as the WTP threshold, the probability of the government-funded LDCT program was 100% for the overall high-risk population, 75.93% for Group FH, and 100% for Group HS.
CONCLUSIONS: Biennial LDCT screening remains cost-effective across all risk groups. Heavy smokers are the most cost-effective subgroup. The dual-criteria group shows the largest mortality reduction, at 37.9%, indicating an additive risk effect from the two exposures combined.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE377
Topic
Economic Evaluation, Health Policy & Regulatory, Medical Technologies
Disease
Oncology