Micro-simulation analysis of the cost-effectiveness of competing lung cancer screening strategies in Germany

Abstract

The US National Lung Cancer Screening Trial (NLST), the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON), the the German Lung Cancer Screening Intervention (LUSI) Trial all showed that lung cancer screening using Low-dose computed tomography (LCDT) reduced lung-cancer mortality. Following favorable results from the trials that lung cancer screening with LDCT could save lives, expert panels in different countries have released recommendations and position statements to support the implementation of population-based screening programmes in Europe, including in Germany. However, more detailed questions remain with regard to the optimization of screening programmes, such that one obtains a maximum benefit (gain in life years) at an acceptable financial cost and at acceptable overall risk for negative side effects that may be caused by false-positive screen tests or over-diagnosis.

Although several microsimulation studies have been performed to evaluate cost-effectiveness of screening with LCDT in different regions, so far no extensive modeling has been performed for the evaluation of the expected benefits, risks of harms and financial costs of diverse lung cancer screening scenarios in Germany. For instance, prevalence rates of smoking and smoking intensity are higher in Europe and in Germany compared to the US and Canada, where most quantitative modeling studies have been conducted. Here, we propose to investigate the benefits, harms and cost-effectiveness of numerous lung cancer screening implementation scenarios for the population of Germany.