Abstract:

Objective: To evaluate the health economic value of lung cancer screening strategies in non-smoking women based on a decision-tree Markov model, to identify the optimal screening strategy to guide policy-making for lung cancer screening. Methods: A decision-tree Markov model for lung cancer screening strategies in non-smoking women aged 50-74 years was constructed using TreeAge Pro 2022 software. The parameters included epidemiological data (incidence and mortality rates), disease transition probabilities, screening and diagnostic performance parameters (modality, starting age, and screening interval), costs and health utility values. These parameters were derived from the China Cancer Registry Annual Report, the China Population Census Yearbook 2020, the 2018 China Adult Tobacco Survey Report, and high-quality published literature from both domestic and international sources. Then simulations were conducted for 100000 individuals each undergoing various low-dose computed tomography (LDCT) screening strategies (screening group) and those not receiving any lung cancer screening (non-screening group). Cost-utility analysis (including indicators such as 2021 gross domestic product (GDP), willingness to pay (WTP), incremental cost-utility ratio (ICUR), quality-adjusted life years (QALY), and life years (LY)) and sensitivity analysis were subsequently performed. Results: Among the lung cancer screening strategies evaluated, all 12 single LDCT screening strategies demonstrated higher per-capita costs (range: 3355.64-10761.40 yuan) compared with the 12 strategies combining the NCC-LC_m2021 model with LDCT (range: 1580.48-3287.68 yuan). The annual single LDCT screening strategy for the population aged 50-74 years had the highest per-capita cost (10761.40 yuan), while the strategy of conducting NCC-LC_m2021 combined with LDCT screening every 5 years for the population aged 60-74 years had the lowest per capita cost (1580.48 yuan). When applying a three times the per-capita GDP (2021 year: 242928 yuan) as the WTP threshold, all screening strategies exhibited cost-utility advantages, with ICUR ranging from 69965.507 yuan/QALY to 158106.667 yuan/QALY. The annual single LDCT screening for the 50-74 years age group was the most cost-effective strategy, yielding 17.173 LY and 16.062 QALY, with an ICUR of approximately 69965.507 yuan/QALY. Sensitivity analysis showed that the ICUR value of generated between 1 and 3 times of the per capita GDP (2021 year) threshold, and the probability of having a cost-effectiveness advantage was 92%. Conclusion: The NCC-LC_m2021 model combined with LDCT for lung cancer screening in non-smoking women incurs lower per-capita costs than single LDCT screening. However, with 3 times the per-capita GDP as the WTP threshold, annual single LDCT screening for the population aged 50-74 years represents the most cost-effective strategy, and has good robustness. Therefore, this strategy is recommended as the priority strategy for lung cancer screening in non-smoking women.

Key words: Tobacco, smokeless, Lung neoplasms, Patient identification systems, Women’s health services, Models, economic, Costs and cost analysis