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

  • 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 Type
      Screening Method
      Cost per life-yr served
      (2012 dollars)
      Lung LDCT (age 55 to 64) $18,662
      LDCT (age 65 to 80) $18,452
      Colorectal
      Colonoscopy
      $18,705
      Breast Mammography $31,309
      Cervical
      Pap smear
      $50,162

      1NEJM 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

  • 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, yrs
    2,825,652
    1,313,423
    1,512,229
    Lead-time correction, yrs
    568,599
    276,563
    292,036
    True life-years saved (0-yr lead time life-year saved, yrs
    2,257,053
    1,036,860
    1,220,193
    Cumulative extra cost, $
    41,647,811,614
    23,241,454,701
    18,406,356,913
    Cost per additional life-year, $
    18,452
    22,415
    15,065
    Patients diagnosed with lung cancer in 2014
    Average life expectancy without screening, yrs
    3.07
    2.81
    3.36
    Avergage life expectancy with screening (with no lead time), yrs
    7.01
    6.30
    7.81
    Avergage increased life span because of screening, yrs
    3.94
    3.49
    4.47

    *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

  • 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.

      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
      Screening
       
       
           Lung cancer
      $27,824,282,242
      $34,054,299,361
           QALYs saved by screening and treatment
      985,284
      722,795
           Cost per QALY saved
      $28,240
      $47,115
      Screening + light smoking cessation intervention
       
       
           Additional costs for cessation
      $1,361,556,665
      $1,361,556,665
           Additional QALYs saved by cessation
      273,566
      273,566
           Cost per QALY saved
      $23,185
      $35,545
      Screening + intensive smoking cessation intervention
       
       
      A. NRT generic plus behavioral
       
       
           Additional costs for cessation
      $3,212,191,737
      $3,212,191,737
           Additional QALYs saved by cessation
      930,754
      930,754
           Cost per QALY saved
      $16,198
      $22,537
      B. Bupropion generic plus behavioral
       
       
           Additional costs for cessation
      $4,088,822,965
      $4,088,822,965
           Additional QALYs saved by cessation
      930,754
      930,754
           Cost per QALY saved
      $16,656
      $23,067
      C. Chantix plus behavioral
       
       
           Additional costs for cessation
      $5,342,861,783
      $5,342,861,783
           Additional QALYs saved by cessation
      930,754
      930,754
           Cost per QALY saved
      $17,310
      $23,826

      NY-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.

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      Adding Smoking Cessation Estimated to Increase QALY and Lower Cost of Screening by 20 to 45%

Smoking Ubiquitous in 1940’s Thru 1980

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