Lung cancer

ALCC 23: Study identifies the best lung cancer risk prediction tool for screening

Associate Professor Marianne Weber

The PLCOm2012 risk prediction tool is not only more accurate than age and smoking history alone but is also more cost-effective in identifying high risk patients for access to a lung cancer screening program.

Speaking at the Australian Lung Cancer Conference on the Gold Coast, Associate Professor Marianne Weber said use of PLCOm2012 over the USPSTF-2013 criteria led to a net benefit of $4,294.

The results will help inform implementation of a proposed Australian lung cancer screening program.

Associate Professor Weber, a Senior Research Fellow at the The Daffodil Centre, presented results from an economic comparison of PLCOm2012 and the USPSTF-2013 using Australian and Canadian data from the International Lung Screening Trial (ILST).

The ILST has previously shown the PLCOm2012 risk prediction tool to be more efficient than the USPSTF2013 criteria in identifying people at high-risk of lung cancer who are likely to benefit from screening. [link to The Lancet here]

The US Preventive Services Task Force (USPSTF) 2013 criteria is simply age 55–80 years, smoking history of ≥30 pack-years, and ≤15 quit-years.

The PLCOm2012 uses 11 criteria of age, race or ethnicity, education, BMI, history of chronic obstructive pulmonary disease, personal history of cancer, family history of lung cancer, and smoking status, smoking intensity (mean number of cigarettes smoked per day), smoking duration, and quit-years in former smokers to calculate the 6-year risk of lung cancer.

The cost-effectiveness study found the PLCOm2012 lung cancer risk model, using a threshold of ≥1.70% at 6 years, resulted in $355 of cost savings per 0.20 QALYs gained over the USPSTF-2013 strategy.

“At a willingness-to-pay threshold of $20 000/QALY, the mean incremental net benefit (INB) was $4294 (95 %CI: $4205–$4383),” the study said.

“The INB of using the PLCOm2012 model for selection in males was $695 (95% CI: $608–$781); in females, using the risk model was more cost-effective: (INB= $6616, 95% CI: $6436–$6796).”

The study said the risk model was most cost-effective at the ≥1.5% at 6 years threshold (INB: $4876) – the threshold Australian and UK governments recommend using in their future screening programs.

“When this threshold was applied, 379 (9%) more ILST participants were eligible for screening and four additional cases of lung cancers would be detected compared to the base-case ≥1.7% / 6 years threshold.”

Associate Professor Weber said a screening program using PLCOm2012 to identify high-risk individuals for entry would save lives and reduce costs.

The study was published this month in Lung Cancer [link here].

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