In a recent publication in the Annals of Internal Medicine, researchers from the Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group, which includes researchers from The University of Texas MD Anderson Cancer Center, conducted a comparative modeling analysis with four validated microsimulation models and aimed to evaluate and compare the cost-effectiveness of risk model–based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.

The data sources included the National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; and the U.S. Smoking History Generator.

The researchers evaluated the cost-effectiveness of lung cancer screening strategies in a simulated population of 1,000,000 men and women who had smoking patterns consistent with the 1960 U.S. birth cohort. The USPSTF recommendations were compared with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial modified 2012 risk prediction model (PLCOm2012) with screening beginning at age 50 or 55 years and with 6-year risk thresholds of 0.5% to 2.2%.

The outcome measures included incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the most significant health benefit at a given cost.

Th results revealed that risk model–based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100,000 per quality-adjusted life-year (QALY).

Additionally, the strategy with a 1.2% risk threshold had an ICER of $94,659, generating more QALYs for less cost than the USPSTF recommendation while having a comparable level of population screening coverage (21.7% vs. 22.6%) but better reduced lung cancer mortality (12.4% vs. 11.8%) compared with 2021 USPSTF, respectively.

The results also showed that the risk model–based strategies were clearly more cost-effective under varying modeling assumptions than the 2021 USPSTF recommendations.

The authors noted that the study had limitations because it employed simulated data, and the findings needed to be validated utilizing real-world data.

The authors concluded, “Lung cancer screening strategies that select persons based on their personal lung cancer risk are robustly more cost-effective than the 2021 USPSTF recommendations. Risk model–based screening is cost-effective under a wide range of risk thresholds, offers flexibility for implementation across different settings, and warrants further consideration.”

Lead author Iakovos Toumazis, PhD, assistant professor of Health Services Research, stated, “Findings from this study could be considered as a potential guide for the development of cost-effective risk model-based lung cancer screening under various settings and availability of health care resources. While the current recommendations are cost effective, our findings suggest that we can improve on these guidelines and provide more flexibility to include those most likely to benefit from lung cancer screening.”

Dr. Toumazis also stated, “Our model shows that personal risk-based screening for lung cancer is cost effective under a wide range of risk thresholds, offering flexibility for implementing risk model-based approaches in a variety of settings that have different health care resources available.”

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