Table 4.
Key Assumptions and Sensitivity Results
| Key cost-benefits model component | Base-case assumption | sensitivity assumption and impact on cost per life-year saved |
|---|---|---|
| Annual treatment cost, by stagea at diagnosis | The 5-year cost to treat a patient diagnosed at stage Aa is approximately 73% of the 5-year cost to treat if the patient was diagnosed at stage Ca | If 5-year treatment costs were the same, regardless of stage at diagnosis, the cost per life-year saved would be higher, at approximately $28,000 |
| Cost of screening | The expected cost of annual screening and follow-up is $241 for each screened patient | If annual screening cost per person was $500, the cost per life-year saved would be approximately $25,000 |
| Stagea at diagnosis | Distribution of stage at diagnosis is consistent with the I-ELCAP experience,12 with 78% at stage Aa | If diagnosed patients exhibit the stage distribution reported in NLST (63% at local early-stage disease),13 the cost per life-year saved would be approximately $24,000 |
| Lung cancers inside/outside screened population | Of lung cancer in patients aged 55–80 years, 80% occur in the population eligible for screening, and 20% of lung cancers occur among those lower-risk patients outside of the target population | If lower-risk females (not eligible for screening) account for patients with lung cancer at twice the rate as males (40% and 20%, respectively), females would cost approximately $16,000 per life-year saved, and the overall cost per life-year saved would be approximately $20,000. If only 50% of all lung cancers occur among the screening-eligible population, the cost per life-year saved would be approximately $22,000 |
| Overdiagnosis/pseudo-disease | No pseudo-disease | If 20% more patients are identified with stage Aa cancer, without any reduction in the number of patients with stage Ba or Ca cancers, the cost per life-year saved would be $20,000 |
a
For this cost analysis, cancer stage was designated as A, B, or C based on treatment patterns for patients in the 9-month period after diagnosis.
I-ELCAP indicates International Early Lung Cancer Action Program; NLST, National Lung Screening Trial.