Supplementary materials: Cost–effectiveness of lung cancer screening with volume computed tomography in Portugal

These are peer-reviewed supplementary materials for the article 'Cost–effectiveness of lung cancer screening with volume computed tomography in Portugal' published in the Journal of Comparative Effectiveness Research.Supplementary table 1: Parametric distributions and the corresponding parameters used to extrapolate survival curvesSupplementary table 2: Unit costs and utilization for recruitment costs.Supplementary table 3: Diagnostic costs based on the unit costs from the NHS tariffs and utilization values from the NELSON studySupplementary table 4: After care costs for lung cancer patients.Supplementary table 5: End-of-life costs per lung cancer patient per cycle.Supplementary table 6: Parameters used for scenario analyses.ReferencesAim: Lung cancer is the most common cause of cancer death in Portugal. The Dutch–Belgian lung cancer screening (LCS) study (NELSON), the biggest European LCS study, showed a lung cancer mortality reduction in a high-risk population when being screened. In this study, the cost–effectiveness of LCS, based on the NELSON study protocol and outcomes, was evaluated compared with no screening in Portugal. Methods: The present study modified an established decision tree by incorporating a state-transition Markov model to evaluate the health-related advantages and economic implications of low-dose computed tomography (LDCT) LCS from the healthcare standpoint in Portugal. The analysis compared screening versus no screening for a high-risk population aged 50–75 with a smoking history. Various metrics, including clinical outcomes, costs, quality-adjusted life years (QALYs), life-years (LYs) and the incremental cost–effectiveness ratio (ICER), were calculated to measure the impact of LDCT LCS. Furthermore, scenario and sensitivity analyses were executed to assess the robustness of the obtained results. Results: Annual LCS with volume based LDCT resulted in €558 million additional costs and 86,678 additional QALYs resulting in an ICER of €6440 per QALY for one screening group and a lifetime horizon. In total, 13,217 premature lung cancer deaths could be averted, leading to 1.41 additional QALYs gained per individual diagnosed with lung cancer. Results are robust based on the sensitivity analyses. Conclusion: This study showed that annual LDCT LCS for a high-risk population could be cost-effective in Portugal based on a willingness to pay a threshold of one-time the GDP (€19,290 per QALY gained).

本为《葡萄牙肺癌筛查中体积计算机断层扫描的成本效益分析》一文的同行评审补充材料。补充表1：用于外推生存曲线的参数分布及其相应参数；补充表2：招募成本的单位成本及利用率；补充表3：基于国家健康服务标准单位成本及NELSON研究利用率值的诊断成本；补充表4：肺癌患者后续治疗成本；补充表5：每位肺癌患者每个治疗周期的终末期成本；补充表6：用于情景分析的参数。参考文献
研究目的：肺癌是葡萄牙最常见的癌症死亡原因。荷兰-比利时肺癌筛查（NELSON）研究，作为最大的欧洲肺癌筛查研究，表明在高危人群中筛查可以降低肺癌死亡率。本研究基于NELSON研究方案和结果，评估了葡萄牙无筛查与筛查的成本效益。研究方法：本研究通过整合状态转移马尔可夫模型对现有决策树进行修改，以评估葡萄牙从医疗保健角度出发的低剂量计算机断层扫描（LDCT）肺癌筛查的健康相关优势和经济影响。分析比较了针对50-75岁有吸烟史的高危人群进行筛查与不筛查的差异。计算了包括临床结果、成本、质量调整生命年（QALYs）、生命年（LYs）和增量成本效益比（ICER）在内的各种指标，以衡量LDCT肺癌筛查的影响。此外，还执行了情景和敏感性分析，以评估所得结果的稳健性。研究结果：年度基于体积的LDCT筛查导致额外成本5.58亿欧元，额外QALYs 86,678个，导致筛查组的ICER为每QALY 6440欧元，并在终身时间范围内。总计可以避免13,217例过早肺癌死亡，每位诊断出肺癌的个体额外获得1.41个QALYs。结果基于敏感性分析稳健。研究结论：本研究表明，针对高危人群的年度LDCT肺癌筛查在葡萄牙可能是成本效益的，基于愿意支付GDP一次性阈值的假设（每获得一个QALY 19,290欧元）。