Shall We Screen Lung Cancer With Low-Dose Computed Tomography? Cost-Effectiveness in Hungary.

Clinical data and cost-effectiveness analyses from several countries support the use of low-dose computed tomography (LDCT) to screen patients with high risk of lung cancer (LC). This study aimed to explore the economic value of screening LC with LDCT in Hungary. Cohorts of screened and nonscreened subjects were simulated in a decision analytic model over their lifetime. Five steps in the patient trajectory were distinguished: no LC, nondiagnosed LC, screening, diagnosed LC, and post-treatment. Patient pathways were populated based on the Hungarian pilot study of screening, the Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) LC screening trial, and local incidence and prevalence data. Healthcare costs were obtained from the National Health Insurance Fund. Utility data were obtained from international sources and adjusted to local tariffs. Scenarios according to screening frequency, age bands (50-74, 55-74 years), and smoking status were analyzed. Annual LDCT-based screening compared with no screening for 55- to 74-year-old current smokers showed 0.031 quality-adjusted life-year (QALY) gains for an additional €137, which yields €5707 per QALY. Biennial screening for the same target population showed that purchasing 1 QALY would cost €10 203. The least cost-effective case was biennial screening of the general population aged 50 to 74 years, which yielded €37 931 per QALY. Screening LC with LDCT for a high-risk population could be cost-effective in Hungary. For the introduction of screening with LDCT, targeting the most vulnerable groups while having a long-term approach on costs and benefits is essential. • Over the years, Hungary has traditionally been reported among the highest incidence and mortality rates of lung cancer in Europe. There are data on the effectiveness of screening: 2 pilot clinical sites have initiated screening with low-dose computed tomography. Cost-effectiveness has not been assessed yet. Research from other countries indicates that cost-effectiveness largely varies by target population for screening. • To the best of our knowledge, this is the first health-economic model to analyze the cost-effectiveness of screening in a Central-Eastern European context. Rather than restricting screening to heavy smokers, the analysis investigates cost-effectiveness for the general population as well. • Low-dose computed tomography in Hungary proves to be cost-effective in the high-risk population segments, especially cohorts with a current smoker population. Cost-effectiveness depends both on the target population and the frequency of screening: selecting the appropriate risk group and setting up adequate logistics are paramount. The introduction of screening programs must be treated with a mid- to long-term focus given that initial budget impact would be high. [ABSTRACT FROM AUTHOR]