Best Practice Advisory in the Electronic Record
Clinical Decision Support Tools
Decision Aid |
Source |
Media |
Individualized risk assessment |
Criteria for positive scan |
Link |
---|---|---|---|---|---|
Should I Screen |
University of Michigan |
Web - Interactive |
Yes |
NLST |
|
LCS with Computerized Tomography (CT) |
American Thoracic Society |
Print |
No |
NLST |
|
LCS Benefits, harms of chest CT scans |
Health Decision |
Web – Interactive |
Yes |
NLST |
|
Lung Cancer: Should I Have Screening? |
Healthwise |
Web – Interactive and print |
No |
NLST |
|
LCS: Yes or No |
Options Grid - Dartmouth Institute |
Web interactive and print |
No |
Lung- RADSTM |
|
LCS |
Center for Clinical Management Research, Ann Arbor VHA |
Web- interactive |
Yes |
NLST |
|
Lung cancer Project |
Genentech |
Web – Interactive and print |
No |
NLST & Lung- RADS™ |
|
LCS Saves Lives |
American Lung Association |
Web – Interactive and print |
No |
NLST |
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Clinical Decision Support Tools
CT Lung Screening Cost Effectiveness Review
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CT screening for lung cancer is cost effective
- Cost effectiveness of CT screening in NLST: $81,000 per QALY gained.1
-
Actuarial analysis suggests screening by LDCT may be as cost effective as other currently recommended screening tests.2,3
Cancer TypeScreening MethodCost per life-yr served
(2012 dollars)Lung LDCT (age 55 to 64) $18,662 LDCT (age 65 to 80) $18,452 ColorectalColonoscopy$18,705Breast Mammography $31,309 CervicalPap smear$50,1621NEJM 2014: 371:1793
2Health Affairs 2012:31:770 American Health & Drug Benefits 2014: 7(5): 272
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CT screening for lung cancer is cost effective
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Actuarial analysis shows lung cancer screening in the Medicare population is less than $19,000 per QALY
Lung Cancer Screening Cost Effectiveness in Medicare Population
$18,452 per QALY
Estimates Impact of Lung Cancer Screening on Life-Years Saved and Cost per Life-Year Saved,* Using Base-Case (I-ELCAP Data for Screening Results) Impact of Screening Total Male Female Cumulative life-years saved, yrs2,825,6521,313,4231,512,229Lead-time correction, yrs568,599276,563292,036True life-years saved (0-yr lead time life-year saved, yrs2,257,0531,036,8601,220,193Cumulative extra cost, $41,647,811,61423,241,454,70118,406,356,913Cost per additional life-year, $18,45222,41515,065Patients diagnosed with lung cancer in 2014 Average life expectancy without screening, yrs3.072.813.36Avergage life expectancy with screening (with no lead time), yrs7.016.307.81Avergage increased life span because of screening, yrs3.943.494.47*Life-years saved and cost are for patients with cancer aged 55-110 years.
I-ELCAP indicates International Early Lung Cancer Action Program.
Source: Authors' analysis.
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Lung Cancer Screening Cost Effectiveness in Medicare Population
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Adding Smoking Cessation Estimated to Increase QALY and Lower Cost of Screening by 20 to 45%
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Micro simulation modelling of lung cancer screening informed by Ontario Canada health insurance data and cancer registry shows annual lung cancer screening can be cost effective in a population setting. Scenario #6 in the graph is the USPSTF guideline criteria and shows Canadians $45,916 per life year gained.
Adding Smoking Cessation Estimated to Increase QALY and Lower Cost of Screening by 20 to 45%
Projected 15-year costs and quality-adjusted life years saved by lung cancer screening and treatment with and without smoking cessation using stage shifts from NY-ELCAP and NLST in authors' actuarial model. NY-ELCAP stage shift NLST stage shift ScreeningLung cancer$27,824,282,242$34,054,299,361QALYs saved by screening and treatment985,284722,795Cost per QALY saved$28,240$47,115Screening + light smoking cessation interventionAdditional costs for cessation$1,361,556,665$1,361,556,665Additional QALYs saved by cessation273,566273,566Cost per QALY saved$23,185$35,545Screening + intensive smoking cessation interventionA. NRT generic plus behavioralAdditional costs for cessation$3,212,191,737$3,212,191,737Additional QALYs saved by cessation930,754930,754Cost per QALY saved$16,198$22,537B. Bupropion generic plus behavioralAdditional costs for cessation$4,088,822,965$4,088,822,965Additional QALYs saved by cessation930,754930,754Cost per QALY saved$16,656$23,067C. Chantix plus behavioralAdditional costs for cessation$5,342,861,783$5,342,861,783Additional QALYs saved by cessation930,754930,754Cost per QALY saved$17,310$23,826NY-ELCAP, New York Early Lung Cancer Action Project; NLST, National Lung Screening Trial; QALY, quality-adjusted life year. doi:10.1371/journal.pone.0071379.t002
Villanti, Andrea & Jiang, Yiding & Abrams, David & Pyenson, Bruce. (2013). A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions. PloS one. 8. e71379. 10.1371/journal.pone.0071379.
Click to View Table:
Adding Smoking Cessation Estimated to Increase QALY and Lower Cost of Screening by 20 to 45%
-
Micro simulation modelling of lung cancer screening informed by Ontario Canada health insurance data and cancer registry shows annual lung cancer screening can be cost effective in a population setting. Scenario #6 in the graph is the USPSTF guideline criteria and shows Canadians $45,916 per life year gained.