Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Implementation of the International Lung Screening Trial in Catalonia (Spain): An Economic Analysis

Version 1 : Received: 3 January 2023 / Approved: 5 January 2023 / Online: 5 January 2023 (11:30:30 CET)

How to cite: Rosell, A.; Baeza, S.; Mouriño, R.; Saigí, M.; Munné, M.; Lopez de Castro, P.; Bechini, J.; Estrada, O.; Ara, J.; López Seguí, F. Implementation of the International Lung Screening Trial in Catalonia (Spain): An Economic Analysis. Preprints 2023, 2023010107. https://doi.org/10.20944/preprints202301.0107.v1 Rosell, A.; Baeza, S.; Mouriño, R.; Saigí, M.; Munné, M.; Lopez de Castro, P.; Bechini, J.; Estrada, O.; Ara, J.; López Seguí, F. Implementation of the International Lung Screening Trial in Catalonia (Spain): An Economic Analysis. Preprints 2023, 2023010107. https://doi.org/10.20944/preprints202301.0107.v1

Abstract

BACKGROUND: The National Lung Screening Trial (ILST) and the NELSON study showed that lung cancer-specific mortality can be reduced by 20-24% using low-dose computed tomography (LDCT) screening in high-risk populations, due to an increase in early-stage diagnoses. RESEARCH QUESTION: How much lung cancer-related direct costs may be reduced using a LDCT screening programme based on the ILST protocol in a public healthcare system?STUDY DESIGN AND METHODS: Cost analysis of lung cancer screening (LCS) vs. usual care in the framework of the retail price of the Catalan public healthcare system. The LCS group included costs of screening (ILST protocol), treatment cost according to weighted average distribution of TNM staging in the NLST and NELSON trials, lung cancer detection rate (CDR) and smoking cessation intervention. The usual care group included treatment costs based on distribution of TNM staging registered in the Spanish index hospital. RESULTS: In the usual care group, treatment costs were €91,959. In the 5-year duration of the LCS programme, the average expected costs per subject were €1,342 (range €1,054-1,832 depending on malignancy in detected nodules) for screening and €32,431 for treatment, with an expected reduction of €952 based on an average CDR of 1.6%. The decrease in cost resulting from stage shift offsets 70.6% of the costs of the screening programme. INTERPRETATION: Baseline 5-year LCS costs are low according to the ILST protocol. In the Catalan public healthcare system, the expense reduction from the stage shift due to the LCS programme compensates a substantial part of its costs.

Keywords

cost analysis; early stage; health economics; lung cancer; screening programme

Subject

Medicine and Pharmacology, Oncology and Oncogenics

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