486P - Fiscal feasibility and implications of integrating lung cancer screening into Hong Kong’s healthcare system

Background

Our research group has previously established the cost-effectiveness (CE) of lung cancer screening (LCS) with low-dose computed tomography (LDCT) for both high-risk smokers and non-smokers in Hong Kong (HK). Integrating LCS into the existing infrastructure in HK however requires systematic and rigorous design and execution. Thus, we undertook sensitivity and scenario analyses for LCS beyond fundamental base-case examination. The aim was to explore balance between clinical efficacy and resource optimization for LCS implementation in HK.

Methods

A CE analysis was conducted using decision tree and state-transition Markov model to simulate identification, diagnosis, and treatments for a high-risk population defined by the NELSON study and the TALENT study. One-way sensitivity analysis (OSA) was conducted with ±20% variation of the base-case parameter values. Scenario analyses were undertaken to explore the CE of LCS with varying costs. The incremental cost-effectiveness (ICER) was estimated as costs per quality-adjusted life-year (QALY).

Results

OSA showed that LDCT costs were the main driver for the ICER of LCS targeting heavy smokers, 20% increase in LDCT costs led to an ICER of USD 18,002 (22% higher than base-case ICER). Meanwhile, 20% increase in the treatments costs for stage I LC led to an ICER of 10,844 (7% higher than base-case ICER) for the LCS targeting high-risk non-smokers. Scenario analyses additionally indicated that restraining costs for CT scan, diagnosis, and early-stage LC treatments would yield a reduction in ICER (Table). Table: 486P

Conclusions

Fiscal restraint on CT scanning and early-stage LC treatments expenditures are necessary to ensure feasible and sustainable LCS implementation in HK. Our findings provide important benchmarks for the HK Government’s consideration.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

AstraZeneca Hong Kong.

Disclosure

H.H.F. Loong: Financial Interests, Institutional, Invited Speaker: Boehringer Ingelheim, MSD; Financial Interests, Personal, Invited Speaker: Eli Lilly, Illumina, Bayer, Guardant Health; Financial Interests, Personal, Advisory Board: Novartis, Takeda. X. Pan: Financial Interests, Personal, Financially compensated role: i-DNA. All other authors have declared no conflicts of interest.