PS 1-50 COST-EFFECTIVENESS OF LUNG CANCER SCREENING WITH LOW DOSE COMPUTED TOMOGRAPHY IN BRITISH COLUMBIA

Purpose: Lung cancer is the leading cause of cancer-related death worldwide. Studies have shown screening with Low Dose Computed Tomography (LDCT) is associated with decreased mortality. A LDCT-based screening program can be formulated in many different ways in terms of the frequency of screening, potential concomitant smoking cessation interventions, and accompanying risk stratification tools. This study aimed to estimate the cost-effectiveness of such options in British Columbia (BC), Canada.

Methods: We used the Cancer Risk Management Model, a previously developed and validated model of lung cancer screening for Canada. We parameterized the CRRM for BC to estimate the outcomes of 22 alternative LDCT-based screening scenarios. The scenarios were based on the combination of the following factors: frequency and number of screening rounds, implementation of a concomitant smoking cessation program, and implementation of pre- and post-screening risk stratification tools.  We calculated the incremental cost, quality-adjusted life years (QALYs), and cost-effectiveness ratio (ICER) over a 20-year time horizon (from 2018 to 2037).

Results: The most cost-effective program was single screening using a post-screening risk stratification tool with an ICER of CAD$12,059/QALY (2015 CAD$) with a gain of 5,618 QALYs and 8,105 life-years. If smoking cessation interventions were an integral part of the screening program, the ICER increases to CAD$20,133/QALY. In both of these scenarios, a sustained decrease in lung cancer treatment costs is observed from the third year of the program. Whether subsequent screening should be offered is an open question. The next policy move, from a cost-effectiveness perspective, would be to increase of frequency of screening to 3 scans in a biennial fashion (see Figure 1).

Conclusion: Overall, the provision of systematic LDCT screening programs in BC is likely to be associated with gains in health but at additional costs. The provision of concomitant smoking cessation programs and risk stratification tools impact the cost-effectiveness of the program.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding: This study was supported by the Health Technology Review (HTR), Province of BC. The views expressed herein do not necessarily represent those of the Government of British Columbia.

Figure 1.  Cost-effectiveness plane