To evaluate the cost-effectiveness of four low-dose computed tomography (LDCT) screening strategies for lung cancer in Singapore, including never smokers.
Approach:
Model Development: A Markov cohort model was developed using demographic, epidemiologic, and clinical data from Singapore to assess LDCT screening strategies.
Economic Evaluation: The analysis followed CHEERS guidelines, focusing on direct medical costs over a lifetime horizon, with costs and outcomes discounted at 3% per year.
Key Findings:
Lung cancer is the leading cause of cancer death in Singapore, with 82% diagnosed at late stages and a 5-year relative survival of 22.1% for males and 38.0% for females.
Approximately 48% of lung cancer cases occur in never smokers, particularly among East Asian females with adenocarcinoma.
Only 38.1% of lung cancer patients meet the NLST screening criteria.
The TALENT trial achieved a 2.6% detection rate in never smokers, prompting national screening initiatives.
Most economic evaluations suggest LDCT screening is cost-effective, but no studies have used Singapore data for never smoker screening.
Interpretation:
The study emphasizes the necessity for tailored screening strategies in Singapore, particularly for never smokers, due to the unique demographic and epidemiological context.
Limitations:
The study did not include individual-level patient data, thus no institutional review board approval was required.
The model's parameters were based on aggregate data, which may limit the applicability of findings and the generalizability of the results.
Conclusion:
The evaluation of LDCT screening strategies in Singapore indicates potential benefits for including never smokers, though further research is needed.
