REAL-WORLD EVIDENCE TO ASSESS THE FEASIBILITY OF LOW-DOSE CT LUNG CANCER SCREENING IN THE BRAZILIAN UNIFIED HEALTH SYSTEM (SUS)
Author(s)
Felipe Fagundes, PhD1, Lívia Loamí Ruyz Jorge Paula, MSc, PhD2, Fabiana de Lima Vazquez, PhD3, Fernanda Franco Munari, MSc2, Talita Garcia do Nascimento Castro, PhD1, Wellington dos Santos, PhD2, Ludmila Pereira Barbosa dos Santos Carvalho, MSc3, Moacyr Campos, MD1, Bruno Tirotti Saragiotto, PhD1, Eduardo Caetano Albino da Silva, MSc4, Alexandre Arthur Jacinto, PhD5, Rachid Eduardo Noleto da Nobrega Oliveira, MD6, Letícia Ferro Leal, PhD3, Rodrigo Sampaio Chiarantano, MSc7, Rui Reis, PhD3.
1Hi! Healthcare Intelligence, São José dos Campos, Brazil, 2Research and Data Science Division, Hi! Healthcare Intelligence, São José dos Campos, Brazil, 3Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil, 4Department of Pathology, Barretos Cancer Hospital, Barretos, Brazil, 5Department of Radiation Therapy, Barretos Cancer Hospital, Barretos, Brazil, 6Department of Thoracic Surgery, Barretos Cancer Hospital, Barretos, Brazil, 7Department of Radiology, Barretos Cancer Hospital, Barretos, Brazil.
1Hi! Healthcare Intelligence, São José dos Campos, Brazil, 2Research and Data Science Division, Hi! Healthcare Intelligence, São José dos Campos, Brazil, 3Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil, 4Department of Pathology, Barretos Cancer Hospital, Barretos, Brazil, 5Department of Radiation Therapy, Barretos Cancer Hospital, Barretos, Brazil, 6Department of Thoracic Surgery, Barretos Cancer Hospital, Barretos, Brazil, 7Department of Radiology, Barretos Cancer Hospital, Barretos, Brazil.
OBJECTIVES: Lung cancer remains a leading cause of cancer mortality in Brazil, with most cases diagnosed at advanced stages. Although LDCT screening reduces lung cancer mortality among high-risk populations, evidence regarding its implementation in middle-income universal healthcare systems remains limited. This study evaluated the feasibility of implementing an organized LDCT lung cancer screening strategy within the Brazilian Unified Health System (SUS), informed by real-world operational data and economic modeling.
METHODS: A model-oriented evaluation was conducted using clinical and operational data from the Barretos Cancer Hospital Lung Cancer Screening Program (BCH-LCSP), one of the few structured LDCT screening initiatives in Brazil. Screening eligibility followed high-risk criteria derived from the NLST and PLCOM2012 model. Real-world metrics — including screening volume, adherence, Lung-RADS distribution, biopsy referrals, and cancer detection patterns — were used to assess implementation requirements and health system readiness. A decision-analytic model integrating a decision tree and Markov structure was developed from the SUS perspective to estimate long-term economic plausibility of organized screening versus usual care.
RESULTS: The BCH-LCSP demonstrated operational feasibility of LDCT screening in a Brazilian real-world setting, establishing standardized pathways for radiologic follow-up, diagnosis, and treatment. Risk-based eligibility enabled prioritization of high-risk individuals, potentially improving resource allocation within SUS. Economic modeling indicated that LDCT implementation requires moderate incremental investment while supporting earlier diagnosis and reducing mortality. Sensitivity analyses demonstrated robustness across variations in diagnostic performance, treatment costs, and adherence assumptions.
CONCLUSIONS: Real-world evidence suggests that LDCT lung cancer screening is operationally feasible for phased SUS implementation when supported by structured eligibility criteria, standardized reporting, and organized follow-up pathways. These findings may inform policy discussions regarding lung cancer screening in middle-income universal healthcare systems.
METHODS: A model-oriented evaluation was conducted using clinical and operational data from the Barretos Cancer Hospital Lung Cancer Screening Program (BCH-LCSP), one of the few structured LDCT screening initiatives in Brazil. Screening eligibility followed high-risk criteria derived from the NLST and PLCOM2012 model. Real-world metrics — including screening volume, adherence, Lung-RADS distribution, biopsy referrals, and cancer detection patterns — were used to assess implementation requirements and health system readiness. A decision-analytic model integrating a decision tree and Markov structure was developed from the SUS perspective to estimate long-term economic plausibility of organized screening versus usual care.
RESULTS: The BCH-LCSP demonstrated operational feasibility of LDCT screening in a Brazilian real-world setting, establishing standardized pathways for radiologic follow-up, diagnosis, and treatment. Risk-based eligibility enabled prioritization of high-risk individuals, potentially improving resource allocation within SUS. Economic modeling indicated that LDCT implementation requires moderate incremental investment while supporting earlier diagnosis and reducing mortality. Sensitivity analyses demonstrated robustness across variations in diagnostic performance, treatment costs, and adherence assumptions.
CONCLUSIONS: Real-world evidence suggests that LDCT lung cancer screening is operationally feasible for phased SUS implementation when supported by structured eligibility criteria, standardized reporting, and organized follow-up pathways. These findings may inform policy discussions regarding lung cancer screening in middle-income universal healthcare systems.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PT27
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Systems & Structure
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology