哮喘联盟

   摘要
   背景：2011年国家肺癌筛查试验报道，在有肺癌高风险的老年人群中，三个年度低剂量计算机断层扫描(LDCT)的肺癌筛查与胸部X线检查相比可以减少20%的肺癌死亡率。讨论已经从临床证据转向可行性。本研究的目旨在确定对于存在肺癌高风险并有商业保险人群(年龄50-64岁)LDCT肺癌筛查是否有成本效益，和量化肺癌筛查程序中综合戒烟干预的额外受益。
   方法和结果：本研究基于先前的评价年度成本效用的仿真模型，15年中对1千800万高风险假定人群重复LDCT筛查，该人群年龄在50～64岁之间并且至少有30年的烟龄。在基本情况下，15年里肺癌筛检干预花费为278亿并且可获得985,284质量调整生命年(QALYs)，获得的每质量调整生命年成本效用率为28,240。戒烟并每年度筛检可以使花费和QALYs的保存增加，成本效用率从16,198每QALY的获得到23,185每QALY的获得。通过所有的敏感性分析，高危人群的每年LDCT肺癌筛查仍具有成本效益。
   结论：本研究表明年龄在50～64岁间的高危人群重复的每年肺癌筛查具有高的成本效用。提供戒烟干预的年度筛查计划可以改善20%-45%的肺癌筛检成本效益。本研究成本效用率的估计与其他接受的癌症筛查干预一致，临床推荐支持包括高危人群年度LDCT肺癌筛查。
 

（刘国梁 审校）
PLoS One. 2013 Aug 7;8(8):e71379. doi: 10.1371/journal.pone.0071379. Print 2013.

 

A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions.
 

Villanti AC, Jiang Y, Abrams DB, Pyenson BS.
 

Abstract
BACKGROUND: A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT) screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50-64) at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program.
METHODS AND FINDINGS: The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs) gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses.
CONCLUSIONS: The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50-64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.
 

PLoS One. 2013 Aug 7;8(8):e71379. doi: 10.1371/journal.pone.0071379. Print 2013.