Economic evaluation of low-dose computed tomography for lung cancer screening among high-risk individuals - evidence from Hungary based on the HUNCHEST-II study

Background: Lung cancer (LC) is the leading cause of cancer-related death in Hungary. Early diagnosis of LC contributes to delivering survival benefits to patients. Low-dose computer tomography (LDCT) is an imaging technology that can be used to identify smaller nodules. The aim of this study was to investigate the cost-effectiveness of introducing organised LDCT screening in Hungary among individuals aged 50 to 74 years with high-risk for developing LC using clinical effectiveness and resource utilisation inputs based on the recent HUNCHEST-II clinical trial.

Methods: We estimated costs and outcomes in a cost-utility analysis framework over the time horizon of 30 years to compare annual and biennial screening for LC with LDCT against standard screening. The economic evaluation simulated a cohort of current and former smokers aged 50 to 74 years with a smoking exposure of at least 25 pack-years, using data from HUNCHEST-II, a multicentre study to evaluate the impact of LDCT screening on early detection of LC. Complementary data were retrieved from published studies and interviews with local experts.

Results: The results of the analysis are favourable from an economic perspective: the introduction of biennial screening for LC with LDCT yielded an incremental effectiveness of 0.031 QALYs as well as an increase in costs of 306 764 HUFs over the 30-year -time horizon when compared to standard screening. The value of the base case ICER (9 908 100 HUF/QALY) of biennial screening for LC with LDCT over standard screening was below the relevant cost-effectiveness threshold. Applying an annual screening strategy using LDCT yielded even more favourable cost-effectiveness results (ICER = 7 927 455 HUF/QALY) compared to biennial screening. Notably, the cost-effectiveness of biennial screening was extendedly dominated by annual screening.

Conclusions: Along with the mature data on its effectiveness, our analysis confirms that using LDCT for LC screening among high-risk individuals is a cost-effective alternative of standard screening in Hungary. Funding a nationwide lung screening program that uses LDCT is a justified decision in economic terms; annual screening would be the optimal strategy to maximize health benefits; however in case of limited financial resources, biennial LDCT screening could offer a cost saving alternative for marginally less health gains than annual screening.