Economic Evaluation of Low-Dose Computed Tomography for Lung Cancer Screening among High- Risk Individuals – Evidence from Hungary Based on the HUNCHEST-II study

Abstract

Background Lung cancer (LC) is the leading cause of cancer-related death in Hungary. Early diagnosis of LC contributes to delivering survival benefits to patients. Low-dose computer tomography (LDCT) is an imaging technology that can be used to identify smaller nodules. The aim of this study was to investigate the cost-effectiveness of introducing LDCT screening in Hungary among individuals aged 50 to 74 years with high-risk for developing LC using clinical effectiveness and resource utilisation inputs based on the recent HUNCHEST II clinical trial. Methods We estimated costs and outcomes in a cost-utility analysis framework over the time horizon of 30 years to compare annual and biannual screening for LC with LDCT against no organised LDCT screening. The economic evaluation simulated a cohort of current and former smokers aged 50 to 74 years with a smoking exposure of at least 25 pack-years, using data from HUNCHEST-II, a multicentre study to evaluate the impact of LDCT screening on early detection of LC. Complementary data were retrieved from published studies and interviews with local experts. Results The results of the analysis are favourable from an economic perspective: the introduction of annual screening for LC with LDCT yielded an incremental effectiveness of 0.053 QALYs as well as an increase in costs of 481 167 HUFs over the full time horizon. The value of the base case ICER (9 143 512 HUF/QALY) of screening for LC with LDCT over no organised screening using LDCT is below the relevant cost-effectiveness threshold. Applying a biannual screening strategy using LDCT yielded less favourable cost-effectiveness results (ICER = 9 908 100 HUF/QALY), although still below the relevant threshold. Similar reduction of lung cancer mortality rate as observed in the NELSON trial might be achieved in Hungary via the LDCT LC screening program. Conclusions Along with the mature data on its effectiveness, our analysis confirms that using LDCT for LC screening in high-risk populations delivers good value for money in Hungary. Funding a nationwide lung screening program that uses LDCT is a justified decision in economic terms; biannual screening frequency is more feasible from budgetary and organisational perspectives.