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Could CT screening for lung cancer ever be cost effective in the United Kingdom?

BACKGROUND: The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although t...

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Autor principal: Whynes, David K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292150/
https://www.ncbi.nlm.nih.gov/pubmed/18302756
http://dx.doi.org/10.1186/1478-7547-6-5
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author Whynes, David K
author_facet Whynes, David K
author_sort Whynes, David K
collection PubMed
description BACKGROUND: The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. METHOD: I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. RESULTS: The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around £7,000. CONCLUSION: It is evident that eventually being able to identify a cost effective regimen of CT screening for lung cancer in the UK is by no means an unreasonable expectation.
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spelling pubmed-22921502008-04-11 Could CT screening for lung cancer ever be cost effective in the United Kingdom? Whynes, David K Cost Eff Resour Alloc Research BACKGROUND: The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. METHOD: I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. RESULTS: The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around £7,000. CONCLUSION: It is evident that eventually being able to identify a cost effective regimen of CT screening for lung cancer in the UK is by no means an unreasonable expectation. BioMed Central 2008-02-26 /pmc/articles/PMC2292150/ /pubmed/18302756 http://dx.doi.org/10.1186/1478-7547-6-5 Text en Copyright © 2008 Whynes; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Whynes, David K
Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title_full Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title_fullStr Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title_full_unstemmed Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title_short Could CT screening for lung cancer ever be cost effective in the United Kingdom?
title_sort could ct screening for lung cancer ever be cost effective in the united kingdom?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292150/
https://www.ncbi.nlm.nih.gov/pubmed/18302756
http://dx.doi.org/10.1186/1478-7547-6-5
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