Analysis Shows CT Lung Cancer Screening Is Cost Effective


ow-dose computed tomography (CT) screening can be cost-effective when compared with no screening among aging smokers, according to a recent analysis of results from the National Lung Cancer Screening Trial.1 The trial, which involved more than 53,000 smokers aged 55 to 74 years, concluded that helical CT scanning reduced mortality from lung cancer by 20% when compared with chest X-rays. The recently published analysis of the trial results was conducted by researchers at Brown University School of Public Health in Providence, Rhode Island, and the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire. The researchers examined the financial implications of screening versus not screening by calculating a ratio of the costs of CT screening per person as well as the number of “quality-adjusted life-years added” per person across the population. The latter distinguishes between individuals living in good health and those living with major health problems. The result was a cost of $81,000 per quality-adjusted lifeyear added, which is considered cost-effective (any sum less than $100,000 is considered cost-effective). Among subgroups, CT screening was more cost-effective in women than men and more economical among patients with high-risk compared with those with low-risk disease. The researchers noted that the cost-effectiveness of CT lung screenings outside the trial may vary depending on how

screenings are implemented. That is because they used many assumptions in calculating the ratio. For example, the investigators assumed that there was no life-prolonging medical benefit to CT screening other than detecting lung cancer. However, when they assumed that other serious conditions would be detected and treated, the ratio fell to $54,000 per quality-adjusted lifeyear added. However, other changes in assumptions brought the ratio to nearly $100,000 or higher. The researchers included the future health costs for survivors (assuming higher costs than in the study for screening, follow-up, or treatment) or more pessimistic assumptions regarding survival or quality of life. When the cost of the test reached $500 (compared with $285 in the National Lung Cancer Screening Trial), cost-effectiveness declined, the researchers noted. Second author Ilana Gareen, PhD, of Brown University, says that among the additional issues that need to be addressed are how frequently patients should be screened, determining the optimal interval between screenings, and whether screening results should impact future screening frequency.

Reference 1. Black WC, Gareen IF, Soneji SS, et al; National Lung Screening Trial Research Team. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med. 2014;371:1793-1802. DOI: 10.1002/cncr.29343


shorter course of androgen deprivation therapy (ADT) combined with radiotherapy (RT) leads to a quicker recovery of normal testosterone levels in patients with prostate cancer, resulting in better quality of life without affecting longterm outcomes, new research has found. The research, presented at the American Society for Radiation Oncology annual meeting (held in September, 2014 in San Francisco, California), analyzed data from 561 patients with high-risk prostate cancer in a multicenter, randomized phase 3 trial in Canada. Patients were randomized into 2 groups: one receiving 18 months of ADT and RT and the other receiving 36 months of ADT and RT. RT was initiated 4 months after the start of ADT in both groups. With a median follow up of 84 months, 55.7% of patients in the 18-month ADT group recovered to normal testosterone

levels compared with 44.9% of patients in the 36-month ADT group. Furthermore, the median time to testosterone recovery was shorter in the patients receiving 18 months versus those receiving 36 months of ADT (47.2 months vs 73.2 months). Patients completed quality-of-life questionnaires prior to treatment, every 6 months during ADT, at 4 months after ADT, and then once a year for 5 years after treatment. As determined by the questionnaires, patients who had testosterone recovery had a better quality of life than those who did not. Currently, the ADT duration guideline for patients with high-risk prostate cancer is between 2 to 3 years. Because of the improvement in testosterone recovery and quality of life, the researchers say that 2 years of ADT may be a good step until final results are obtained. DOI: 10.1002/cncr.29285


Quality of Life in Patients With High-Risk Prostate Cancer Improves With Shorter Course of Androgen Deprivation Therapy

Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.


April 1, 2015


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Analysis shows CT lung cancer screening is cost effective.

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