Health Economics Evaluation Study Of LDCT Screening Strategy For Lung Cancer In Urban Anhui Province

Objective Lung cancer poses a serious risk to human life and health.Since 2014,LDCT screening for lung cancer has been carried out in Anhui Province,but the economic rationality of the cost of the screening program has yet to be demonstrated.In this study,we used Markov decision model to comprehensively evaluate the epidemiological and economic effects of LDCT screening among high-risk groups of lung cancer in Anhui Province,and provide an economic basis for improving and further promoting lung cancer screening strategy.The quality of life of patients under different disease stages of lung cancer was also studied to provide reference information for this research work and other related scientific studies in the future.Methods A Markov decision model for LDCT screening intervention based on the natural progression history of lung cancer disease was constructed based on the current lung cancer screening model in Anhui Province.By using cohort simulation method to simulate the development of the population under different interventions,life years saved(LYS)and quality-adjusted life years(QALY)were used as effect indicators and utility indicators,and cost-effectiveness,cost-utility,and cost-effectiveness analyses were performed for different screening strategies.The distribution parameters of the initial states in the model were obtained from the report of the Anhui Urban Cancer Early Diagnosis and Treatment Project;the probability of metastasis among different disease states and the incidence rate,mortality rate,and five-year survival rate of lung cancer were obtained from published literature;the parameters of screening cost and treatment cost were obtained from the field survey of early diagnosis and treatment of cancer in Anhui Cancer Hospital;the parameters of health utility value were obtained from the health economics follow-up survey of lung cancer patients The health utility value parameters were obtained from the health economics follow-up survey of lung cancer patients,and the quality of life data of different lung cancer stages obtained from the field survey were converted into health utility value parameters by applying the Chinese EQ-5D-5L health utility value score system.Results(1)According to the field survey on early diagnosis and treatment of cancer in urban Anhui Province,the average cost of lung cancer screening per case was RMB 646.65/person.(2)The quality of life health utility values for lung cancer patients under different pathological stages were 0.893 for stage Ⅰ lung cancer,0.888 for stage Ⅱ lung cancer,0.788 for stage Ⅲ lung cancer,and 0.718 for stage Ⅳ lung cancer.(3)Compared with the no-screening group,the epidemiological effect of LDCT lung cancer screening in Anhui Province was significant.The best effect of 1-year 1-time LDCT screening for people aged 40-69 years could reduce the risk of lung cancer by 43.32%and,at the same time,reduce the mortality rate by 13.36%.2-year 1-time,3-year 1-time and 5-year 1-time screening strategies could reduce the mortality rate by 9.14%,6.66%and 3.03%,respectively.(4)Cost-effectiveness and cost-utility analyses showed that during the 35 years of LDCT lung cancer screening in urban areas of Anhui Province,screening of high-risk lung cancer patients aged 40 years or older was consistent with the cost-effectiveness principle for every LYS or QALY saved by each screening program compared with the unscreened group.The screening strategy with the best costeffectiveness ratio was 1 LDCT lung cancer screening at 3 years,at which point saving a life year(LYS)cost the least,$8591.67/LYS.the screening strategy with the best cost-utility ratio was also 1 LDCT screening at 3 years,at which point saving a quality-adjusted life year(QALY)cost $55852.17,followed by 1 screening at 5 years screening strategy($60,629.35/QALY).The cost-effectiveness analysis showed that the 1-year,2-year,3-year,and 5-year screening strategies were all cost-effective,with the highest benefit-cost ratio of 15.11 in the 3-year 1-time LDCT screening group.Conclusions(1)Early lung cancer has a high survival rate and a low disease burden compared with advanced lung cancer,so early detection,early diagnosis and early treatment of early lung cancer are of great significance.(2)Compared with early-stage lung cancer,patients with advanced lung cancer have worse quality of life.(3)Compared with no screening,the implementation of LDCT screening in high-risk groups of lung cancer has cost effectiveness and cost-utility value in terms of life years saved and quality-adjusted life years(QALYs),indicating that the implementation of LDCT screening in high-risk groups in Anhui Province is economical and worthy of promotion in the province.(4)The strategies for different screening frequencies were all optional strategies,and the best screening strategy was once in 3 years.In order to obtain a better screening effect and maximize the prevention and treatment of lung cancer,the frequency of screening can be appropriately increased.