Table 1.
Model Parameters, Utilities, and Sources
| Parameter | Description | Source |
|---|---|---|
| Lung Cancer Incidence | Bach et. al. annual lung cancer incidence prediction model | (25) |
| Lung Cancer Histology | Prediction model developed for this study and derived from control arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial | (18) |
| (see supplement for model development and accuracy) | ||
| Lung Cancer Stage | Using Surveillance, Epidemiology, and End Results data, conditioned on gender and histology | (23,24) |
| Lung Cancer Detectability | Sensitivity of LDCT screen by stage, histology, and screening round; calibrated to National Lung Screening Trial (NLST) CT arm | (31) |
| Lung Cancer-Specific Mortality | Using Surveillance, Epidemiology, and End Results data and Cancer Survival Analysis Software, calibrated to NLST, and conditioned on gender, age group, histology and stage | (1,29,32) |
| Other-Cause Mortality | By age, sex, pack-years, and smoking status using a published model | (23,24) |
| Baseline and Lung Cancer Utilities | From National Lung Screening Trial cost-effectiveness analysis and the Cancer Care Outcomes Study | (5,33) |
| Diagnostic tests, Diagnostic Complications, and Treatment | By stage, as observed in NLST | (1) |
| Disutilities (i.e.,
“degree of dislike” as deductions in days of
quality-adjusted life): Base-case and range of values used in primary
analyses (20) | |||
|---|---|---|---|
| Parameter | Base-Case (20)* | Favors Screening* | Against Screening* |
| Screening & Follow-up Imaging | −0.365 days | −0.0365 days | −3.65 days |
| Invasive Procedures | −10.95 days | −3.65 days | −18.25 days |
| Minor Complication | −3.65 days | −1.825 days | −7.3 days |
| Intermediate Complication | −10.95 days | −3.65 days | −21.9 days |
| Major Complication | −65.7 days | −18.25 days | −83.95 days |
| Surgery/Post-op period | −65.7 days | −18.25 days | −83.95 days |
| Radiation and/or Chemotherapyγ | −51.1 days | −69.35 days | −10.95 days |
Disutilities result in short term decrements in quality of life. They are subtracted from a person’s baseline utility in each year that an event occurs. With the exception of screening and follow-up imaging, our disutilities and their ranges were the same as a prior cost-utility analysis (20), which derived values for disutilities using a systematic review of cost-utilitity assessments in oncology (34). We assigned disutility to the screening and follow-up test as discussed in the text.
Radiation/chemotherapy works opposite from all other procedures/complications; a larger decrement in quality of life for radiation/chemotherapy (i.e., a more negative disutility) favors screening. This is because fewer patients in the screened cohort will be diagnosed with late-stage cancer due to the stage-shift with screening. Thus, fewer in the screened cohort will receive radiation/chemotherapy compared to no screening, so a higher chemo/radiation disutility advantages screening.