We aimed to directly compare the cost-effectiveness of Hungarian (following the NELSON trial) and NLST screening protocols, two trials influencing lung-cancer-screening implementation internationally. A decision-analytic model analyzing the cost-effectiveness of Hungarian protocols was manipulated to reflect the protocols of the NLST, while maintaining features specific to the Hungarian healthcare setting. In the Hungarian protocol, there are three possible outcomes to the initial round of screening, positive, negative, and indeterminate, indicating an uncertain degree of suspicion for lung cancer. This protocol differs from the NLST, in which the only possible screening outcomes are positive or negative, with no indeterminate option. The NLST pathway for smokers aged 55–74 resulted in a EUR 43 increase in the total average lifetime costs compared to the Hungarian screening pathway and resulted in a lifetime gain of 0.006 QALYs. The incremental costs and QALYs yielded an ICER of 7875 EUR/QALY. Our results demonstrate that assigning any suspicious LDCT screen as a positive result (NLST protocol) rather than indeterminate (Hungarian protocol) can reduce patient uncertainty and yield a slight QALY gain that is worth the additional use of resources according to Hungary’s willingness-to-pay threshold. A stratified analysis by age was also conducted, revealing decreasing cost-effectiveness when screening older cohorts. Our study provides insight into the cost-effectiveness, advantages, and disadvantages of various LDCT screening protocols for lung cancer and can assist other countries as they implement their screening programs.
本研究旨在直接比较匈牙利（遵循NELSON试验方案）与美国国家肺癌筛查试验（NLST）两种在国际肺癌筛查实践中具有影响力的筛查方案的成本效益。通过调整原用于分析匈牙利方案成本效益的决策分析模型，使其反映NLST方案特征，同时保留匈牙利医疗体系特有的设置参数。匈牙利方案中，首轮筛查可能出现三种结果：阳性、阴性及不确定（提示存在不确定程度的肺癌可疑性）。该方案与NLST存在显著差异，后者仅设阳性与阴性两种筛查结果，未设置不确定选项。针对55-74岁吸烟人群的模拟分析显示：与匈牙利筛查路径相比，NLST路径使人均终生医疗总成本增加43欧元，同时获得0.006质量调整生命年（QALY）的增益。增量成本效益比（ICER）为7875欧元/QALY。研究结果表明：将可疑低剂量CT筛查结果判定为阳性（NLST方案）而非不确定（匈牙利方案），既能降低患者的不确定性，又能获得虽微小但具有经济学价值的QALY增益——根据匈牙利的支付意愿阈值，这种资源额外投入具有成本效益。分层年龄分析进一步揭示，筛查人群年龄越大，成本效益呈现递减趋势。本研究通过系统比较不同低剂量CT肺癌筛查方案的成本效益与优劣特征，可为各国实施筛查计划提供重要决策参考。
肿瘤(癌症)患者之家