OBJECTIVES

Discussions regarding the implementation and cost-effectiveness of lung cancer (LC) screening using low-dose computed tomography (LDCT) are ongoing. One way to potentially increase economic viability is by introducing combination screening. Whether extending LC screening with screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is beneficial can be investigated in a headroom analysis. This study aimed to estimate the maximum acceptable cost (headroom) per screened individual for LDCT LC screening and determine how this estimate is impacted by additionally screening for COPD, CVD or both.

METHODS

A decision model was developed to determine the headroom of once-off screening for LC, COPD and CVD (Big-3) in different combinations, compared to usual care (no screening) for a population of current and former smokers, aged 50-75 years in the Netherlands. The effectiveness gap in quality-adjusted life-years (QALYs) gained per screened individual was estimated, which in combination with the disease cost and the willingness-to-pay (WTP) provided the headroom per screened individual. The gain in QALYs was based on a shift in disease stage at diagnosis, where asymptomatic patients undergoing screening are detected in an earlier disease stage or with lower disease risk than when detected through symptoms. Data from literature was used to populate the model.

RESULTS

The maximum acceptable cost per individual for LC screening is €90, adding only COPD increased this to €220, adding only CVD increased this to €900 and screening for the Big-3 combined yielded €950, for a WTP of €20 000/QALY gained. The headroom for combination screening of smokers in the Netherlands is €700 and for all individuals over 60 years-of-age, is €1078.

CONCLUSIONS

Extending LC screening with CVD screening results in larger headroom than adding COPD screening. The headroom is largest for combination screening of the Big-3 but depends heavily on the target screening population.