Efficacy and cost-effectiveness of lung cancer screening in France with low-dose computed tomography

Abstract

Lung cancer is the third most frequent cancer in France. It has a poor prognosis when patients are diagnosed at advanced stages. Low-dose computed tomography (LDCT) can detect early-stage cancer. In addition, blood-based biomarkers could help select patients for lung cancer screening or manage indeterminate lung nodules. The objective of this study is to assess the efficacy and cost-effectiveness of lung cancer screening in the French context including LDCT and biomarkers. A microsimulation model calibrated for France was used to compare four strategies: no screening, biennial LDCT, biennial LDCT followed by biomarkers, and biennial screening with biomarkers followed by LDCT. Screening eligibility included age (50-74) and smoking history (>15 cigarettes/day over 25 years, or 10 cigarettes/day over 30 years, or former smokers who quit less than 10 years ago). A 25% participation rate was assumed. Direct medical costs were estimated from the perspective of the French health system. Cost and outcomes were discounted at 2.5%. Screening decreased lifetime lung cancer mortality from 2 to 12% depending on the participation rate, leading to an increase in both life years and quality-adjusted life years (QALY). Considering cost effectiveness, LDCT screening was associated with an incremental cost-effectiveness ratio of €7629 per QALY in comparison to the absence of screening. Sensitivity analyses were all favorable to LDCT-based screening strategies. Biennial LDCT screening could be an effective and cost-effective strategy in France even at a 25% participation rate.

Keywords: biomarkers; cancer screening; low-dose computed tomography; lung cancer; smoking.