Are the 2021 USPSTF Lung Cancer Screening Guidelines Cost-Effective?

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Tweaking the eligibility criteria a bit more could lower healthcare costs further, wrote a team led by Iakovos Toumazis, PhD, of the University of Texas MD Anderson Cancer Center in Houston.

“[Our] the economic evaluation found that the USPSTF’s 2021 recommendation for lung cancer screening was cost-effective; However, alternative screening strategies that maintain a minimum cumulative exposure to smoking of 20 pack-years but include individuals who have quit smoking within the past 25 years may be more cost-effective and warrant further evaluation, ”noted the group.

In March, the USPSTF released updated guidelines that reduced the starting age for CT lung cancer screening from 55 to 50 and adjusted the smoking history from 30 pack-years to 20 pack-years. years. Toumazis and his colleagues investigated whether this new recommendation was more cost-effective than the 2013 task force guidelines, and they also analyzed six other screening strategies that maintained the 20-pack-year measure and set an end age. screening at age 80 but varied in starting age. for screening and number of years since quitting smoking.

The authors used simulated models based on a 1960 birth cohort and a period between January 2005 and December 2050. They defined a cost-effective lung cancer screening strategy as a strategy with a differential cost-effectiveness (ICER ) average less than $ 100,000 per grade. -adjusted life year (QALY).

What did the group find? The 2021 CT lung cancer screening guideline is more cost-effective than the 2013 iteration – despite expanding the pool of eligible people. But that wasn’t the best option over the six alternative strategies, the team noted.

Of these other protocols, two were particularly effective in reducing costs while providing the greatest health benefits (such as higher number of cases detected by screening, lower percentage of overdiagnosed cases, lung cancer deaths averted and reduction in disease mortality – what the team called the “frontier of effectiveness”).

Highest Cost-Effectiveness and Health Benefits of CT Lung Cancer Screening Strategies
Measure USPSTF Recommendation 2021 Alternative Strategy 4 (screening begins at age 55 and ends at age 80; minimum cumulative smoking exposures of 20 pack-years and maximum of 25 years since cessation) Alternative Strategy 6 (Screening starting at age 50 and ending at age 80; minimum cumulative smoking exposure of 20 pack-years and maximum of 25 years since cessation)
Average ICER per QALY earned $ 72,564 $ 66,533 $ 73,952
Average ICER per QALY Gained vs. USPSTF 2013 Efficiency Frontier Strategy $ 104,273 $ 74,502 $ 87,115
Cases detected by screening 1,254 1331 1394
Percentage of overdiagnosis 6% 6.2% 6%
Lung cancer deaths averted 467 487 519
Reduced lung cancer mortality 11.7% 12.2% 13%

Even though Alternative Strategy 4 had a lower ICER per QALY than some of the other screening options, it provided “screening coverage to a portion of the U.S. population similar to that of the 2021 USPSTF recommendation” and “was associated with an higher cost. -effectiveness, improvement in lung cancer-specific mortality and reduction in the number of low-dose CT scans, ”the team explained.

The study results indicate the work that needs to be done to firmly establish the uptake of lung cancer screening, according to an accompanying editorial written by Dr. James Mulshine of Rush University Medical Center in Chicago and his colleague Bruce Pyenson of Millman in New York.

“The time has come for a concerted effort to implement lung cancer screening,” the two wrote. “The many improvements in lung cancer screening from the NLST [National Lung Screening Trial], ranging from underlying technologies and patient support to intervention management, means that the screening process is likely to be even more beneficial than in previous trials. The substantial increase in the costs of treating late-stage lung cancer makes the economic case for early detection even more evident. “

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