Economic Evaluation of a Lung Cancer Screening Program in Denmark

Abstract

Background: Around the world, cancer is a leading cause of death, and in Denmark, lung cancer is the most deadly type of cancer. Early detection can increase survivability. As the early stages of lung cancer are often asymptomatic, a lung cancer screening program could be a means for early detection. Several randomized clinical trials have been conducted to evaluate the effectiveness of the lung cancer screening program. However, there is no study conducted in Denmark evaluating the program's cost-effectiveness. Objective: Conduct a cost-utility analysis to determine the cost-effectiveness of a low-dose computed tomography lung cancer screening program for a specified risk group, applying Danish costs. Methods: A cost-utility analysis is conducted using Danish costs from a healthcare payer perspective, and quality-adjusted life-years gathered through the standard gamble method. The cohort includes heavy former or current smokers with a ≥30 smoking history between ages 55 and 74. The output was illustrated through a decision tree and created two cohort Markov models, with 15 one-year cycles. The first Markov model included the current standard clinical diagnosis pathway, and the second one included diagnosis through an annual lowdose computed tomography lung cancer screening program. The output is measured as costs, quality-adjusted life-years, and total diagnosed and dead. Data and parameters used in the Markov model were gathered from current literature and research. Deterministic sensitivity analysis was conducted. Results: The base case result is cost-effective and expressed through the incremental cost-effectiveness ratio of 721,101 DKK/quality-adjusted life-years below the Swedish threshold of 881,316 DKK/quality-adjusted life-years. The epidemiological results showed more individuals diagnosed and fewer dead patients in the screening cohort versus the current clinical pathway cohort. The deterministic sensitivity analysis showed robustness against several parameters but not all. Conclusion: Introducing a low-dose computed tomography lung cancer screening program in Denmark could be effective for the defined risk group but more costly than the current clinical care.