低剂量计算机断层扫描筛查肺癌成本效益的系统评价

SCI

27 MAy 2022

Systematic review of the cost-effectiveness of screening for lung cancer with low dose computed tomography

(Lung Cancer, IF: 5.705)

• Helen Grover, William King, Nawaraj Bhattarai, Eoin Moloney, Linda Sharp, Liz Fuller

• CORRESPONDENCE TO: helen.grover1@nhs.net

Objectives 目标

Lung cancer (LC) remains a burden for patients and healthcare systems, with most cases only diagnosed once disease is late stage. Screening for LC with low-dose computed tomography (LDCT) has shown a stage shift and led to a lung cancer-specific mortality reduction. Economic evaluations have been conducted which explore the benefits and costs of screening, however, previous systematic reviews concluded results were heterogeneous. LC screening has evolved and there have been further cost-effectiveness analyses conducted. The aim of this study was to provide an up-to-date systematic review of the cost-effectiveness of LC screening with LDCT.

肺癌（LC）仍然是患者和医疗系统的负担，大多数病例只有在疾病晚期才被诊断。用低剂量计算机断层扫描（LDCT）筛查LC显示出阶段性转变，并实现肺癌特异性死亡率降低。通过经济评估探讨了筛查的益处和成本，然而，之前的系统评价得出的结论具有异质性。LC筛查已经进步，并进行了进一步的成本效益分析。本研究的目的是对LDCT筛查LC的成本效益进行最新的系统评价。

Methods and Materials 方法和材料

Databases were searched for full papers published in English 01/1994-02/2022. Inclusion criteria was full economic evaluation of LC screening using LDCT compared to either no screening or chest X-ray.

在数据库中搜索1994年1月至2022年2月间以英文发表的完整论文。纳入标准是使用LDCT对LC筛查进行全面经济评估，与未筛查或使用胸部X光检查筛查进行比较。

Results 结果

Forty-five evaluations were identified, three conducted alongside trials and 42 modelling studies. Thirty-nine evaluations (86.7%) found LC screening with LDCT to be cost-effective. Several findings were broadly consistent across studies: cost-effectiveness was optimal in those age 55-75 years and smoking history of at least 20 pack-years. Biennial screening was often more cost-effective than annual screening and would likely result in less additional findings and radiation exposure. A smoking cessation intervention alongside screening improved cost-effectiveness, but which intervention was optimal was unclear. Risk predictions models using more parameters to target participants for screening did not have more benefits than those using age and smoking alone, and cost-effectiveness was equivalent. Cost-effectiveness was sensitive to cost and specificity of LDCT, and disutility associated with screening.

明确了45篇评估，包括3项与临床试验同时进行的评估和42篇建模研究。39篇评估（86.7%）发现使用LDCT进行LC筛查具有成本效益。多项研究结果基本一致：55-75岁、吸烟史至少20包年的人群成本效益最佳。两年一次的筛查通常比每年一次的筛查更具成本效益，可能会减少额外发现和辐射暴露。在筛查的同时进行戒烟干预可以提高成本效益，但目前尚不清楚哪种干预措施最佳。使用更多参数对参与者进行筛查的风险预测模型与仅使用年龄和吸烟的模型相比没有更多的益处，成本效益相当。成本效益对LDCT的成本和特异性敏感，与筛查的无用性相关。

Conclusion 结论

Overall, LC screening with LDCT is cost-effective in a high-risk population. Questions remain regarding risk prediction models, smoking cessation interventions and appropriateness of utility values in the screened population. Once these uncertainties are addressed, further economic evaluation may be required to inform policy makers prior to implementation.

总体而言，在高危人群中，使用LDCT进行LC筛查是经济有效的。关于风险预测模型、戒烟干预措施以及筛查人群效用值的适当性仍然存在问题。一旦这些不确定性得到解决，我们可以进行进一步的经济评估，以便在实施之前通知政策制定者。