基于风险模型的肺癌筛查：成本效益分析。
Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis.
机构信息
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (I.T., M.H.).
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan (P.C., J.J.).
出版信息
Ann Intern Med. 2023 Mar;176(3):320-332. doi: 10.7326/M22-2216. Epub 2023 Feb 7.
BACKGROUND
In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.
OBJECTIVE
To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.
DESIGN
Comparative modeling analysis.
DATA SOURCES
National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.
TARGET POPULATION
1960 U.S. birth cohort.
TIME HORIZON
45 years.
PERSPECTIVE
U.S. health care sector.
INTERVENTION
Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.
OUTCOME MEASURES
Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.
RESULTS OF BASE-CASE ANALYSIS: Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).
RESULTS OF SENSITIVITY ANALYSES
Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.
LIMITATION
Risk models were restricted to age, sex, and smoking-related risk predictors.
CONCLUSION
Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.
PRIMARY FUNDING SOURCE
National Cancer Institute (NCI).
背景
美国预防服务工作组（USPSTF）在其 2021 年肺癌筛查建议更新中评估了基于个人肺癌风险选择人群的策略（风险模型为基础的策略），强调需要进一步研究风险模型为基础的筛查的获益和危害。
目的
评估和比较基于风险模型的肺癌筛查策略与 USPSTF 建议的成本效益，并探讨最佳风险阈值。
设计
比较建模分析。
数据来源
国家肺癌筛查试验；监测、流行病学和最终结果计划；美国吸烟史生成器。
目标人群
1960 年美国出生队列。
时间范围
45 年。
视角
美国医疗保健部门。
干预措施
50 岁或 55 岁开始使用基于风险模型的策略进行年度低剂量计算机断层扫描，80 岁停止筛查，使用 PLCOm2012 模型，6 年风险阈值在 0.5%至 2.2%之间。
结果衡量
增量成本效益比（ICER）和连接成本效益最高的策略的成本效益效率前沿，以给定的成本。
基础分析结果
基于风险模型的筛查策略比 USPSTF 建议更具成本效益，并且完全构成成本效益效率前沿。在效率前沿上的策略中，6 年风险阈值为 1.2%或更高的策略具有成本效益，ICER 低于每质量调整生命年（QALY）10 万美元。具体来说，风险阈值为 1.2%的策略具有 94659 美元的 ICER（模型范围为 72639 美元至 156774 美元），在比 USPSTF 建议花费更少的成本下提供了更多的 QALYs，而筛查覆盖率（接受筛查的人数）相似（21.7%与 USPSTF 的 22.6%）。
敏感性分析结果
在不同的建模假设下，基于风险模型的策略比 2021 年 USPSTF 建议更具成本效益。
局限性
风险模型仅限于年龄、性别和与吸烟相关的风险预测因子。
结论
基于风险模型的筛查比 USPSTF 建议更具成本效益，因此值得进一步考虑。
主要资金来源
美国国家癌症研究所（NCI）。
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