Targeted lung cancer screening in the age of immunotherapies and targeted therapies – an economic evaluation for AustraliaResearch in context

Abstract

Summary: Background: The cost-effectiveness of different lung cancer screening strategies has been evaluated from an Australian public health system perspective using static models. In addition, the impact of novel therapies, including immunotherapies and targeted therapies, on the cost-effectiveness of lung cancer screening has not yet been evaluated comprehensively. We evaluated the benefits, harms and cost-effectiveness of a targeted national lung screening program in Australia, accounting for the increasing uptake of novel therapies, which informed the lung cancer screening recommendations of the Australian Medical Services Advisory Committee (MSAC). Methods: Australia-specific data on lung cancer epidemiology, smoking behaviour and care costs were used to adapt the MIcrosimulation SCreening ANalysis (MISCAN)-Lung model. Benefits, harms and cost-effectiveness of different targeted lung cancer screening scenarios were evaluated for individuals born between 1945 and 1969. The scenarios considered various screening age ranges, intervals and eligibility criteria (minimum accumulated smoking history and PLCOm2012 risk thresholds). Findings: The MSAC-recommended scenario was cost-effective at AUD62,754 per quality-adjusted life-year compared to no screening. This scenario biennially screens current and former smokers (quit ≤10 years ago) who smoked ≥30 pack-years between ages 50 and 70, preventing 62 lung cancer deaths per 100,000 and yielding 8.4 quality-adjusted life-years per prevented lung cancer death. Using novel therapies reduced the incremental costs of screening compared to no-screening by 14.8% but yielded 11.3% fewer incremental quality-adjusted life-years compared to traditional anti-cancer therapies, due to the improved survival yielded by novel therapies. Overall, the cost-effectiveness of screening was better when costs and effects of novel therapies were applied (AUD62,754 vs AUD65,340 per quality-adjusted life-year gained; 4% difference). Interpretation: Targeted lung cancer screening is more cost-effective when costs and effects of novel therapies are applied, although impacts on cost-effectiveness are likely to be marginal. Funding: Cancer Australia.

Keywords

• Personalised lung cancer screening
• Australia
• Cost-effectiveness
• Immunotherapy
• Population-based screening