最优肺癌 CT 筛查策略:纳入 NELSON 证据、不断变化的治疗成本与戒烟干预的成本效益研究
The Optimal Lung Cancer Ct Screening Strategy: A Cost-Effectiveness Study Incorporating Nelson Evidence, Evolving Cost of Treatment and Smoking Cessation Interventions.
作者
作者单位
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, CE, the Netherlands.
摘要
中文
全球范围内,肺癌筛查的实施正在逐步成形。项目设计需要明确入选标准、筛查间隔及最优年龄范围。本研究整合 NELSON 研究结果、戒烟干预、当代治疗成本以及可行的 CT 容量管理,评估了不同竞争策略的获益与风险。研究者使用 MISCAN-Lung 微模拟模型(以 NELSON 和 NLST 数据进行校准)对 1080 种策略进行了评价。基于代表性吸烟史生成器,模拟了 1945-1979 年出生的荷兰队列。对每种策略评估其(成本)效益、CT 需求量以及戒烟干预(药物治疗)的增量获益。结果显示肺癌筛查总体具有成本效益。基于风险的招募(PLCOm2012)较 pack-year 标准更高效。对 >1.5% 肺癌风险人群进行 55-75 岁年度筛查具有成本效益(ICER<€2 万),相对于不筛查,每获得一个质量调整生命年(QALY)的成本为 €12,201(相对于较低强度筛查为 €19,713)。在人群中,完全依从筛查时肺癌死亡率可降低 10.8%(每年 1072 例),50% 依从时可降低 6.2%。筛查的前三年,按 50% 依从计算,该策略需要全国 CT 总量增加 16.1%。近一半的 CT 成本可由终末期医疗支出的减少所抵消。整合戒烟干预的成本效益为 €10,043/QALY(相对于无整合戒烟的筛查),可额外获得 32% 的生命年。肺癌筛查的成本效益日益提高,可作为实施的关键考量,包括整合戒烟干预在内。本研究发现,对 >1.5%(PLCOm)风险人群进行 55-75 岁年度筛查在 €2 万支付意愿阈值内具有成本效益且 CT 需求可行。
English
Lung cancer screening implementation is taking shape worldwide. Programme design requires specifying eligibility criteria, screening interval, and the optimal age range. We estimate benefits and harms of competing strategies, integrating NELSON results, smoking cessation interventions, contemporary treatment costs, and the management of feasible CT capacity. 1080 strategies are evaluated using the MISCAN-Lung microsimulation model, calibrated to NELSON and NLST data. 1945-1979 Dutch cohorts are simulated using a representative smoking history generator. For each strategy, the (cost-)effectiveness is evaluated, as well as CT requirements and the incremental benefit of a smoking cessation intervention (pharmacotherapy). Lung cancer screening was found to be cost-effective overall. Risk-based recruitment (PLCOm2012) is more efficient than pack-year-based criteria. Annual screening ages 55-75 from > 1.5% lung cancer risk is cost-efficient (ICER < €20 k), and would cost €12,201 per quality-adjusted life-year (QALY) relative to no screening (or €19,713 compared to less intensive screening). Population-wide, lung cancer mortality would be reduced by 10.8% (1072 cases/year) at full uptake, or by 6.2% at 50% uptake. For the first three years, at 50% uptake of screening, the strategy requires a 16.1% increase of national CT volume. Nearly half of CT costs are offset by reductions in terminal care expenditures. Integrated smoking cessation is cost-effective at €10,043/QALY (relative to screening without integrated cessation), yielding 32% additional life-years gained. Lung cancer screening is increasingly cost-effective and may be critically considered for implementation, including integrated smoking cessation. We find annual screening ages 55-75 for those > 1.5% (PLCOm) risk to be within a €20 k willingness-to-pay and feasible CT requirements.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 4.9
- 新锐分区
- 2区