Annals of Oncology Advance Access originally published online on February 24, 2006
Annals of Oncology 2006 17(5):785-793; doi:10.1093/annonc/mdl023
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© 2006 European Society for Medical Oncology
Computed tomography screening for lung cancer in Hodgkin's lymphoma survivors: decision analysis and cost-effectiveness analysis
1 Department of Radiation Oncology, U.T. M.D. Anderson Cancer Center, Houston, TX; Departments of 2 Radiation Oncology and 3 Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School; 4 Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
* Correspondence to: P. Das, Department of Radiation Oncology, U.T. M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 97, Houston, TX 77030, USA. Tel: +1-713-563-2300; Fax: +1-713-563-2366; E-mail: PrajDas{at}mdanderson.org
Background: Hodgkin's lymphoma patients have an elevated risk of developing lung cancer and may be targeted for lung cancer screening. We used a decision-analytic model to estimate the potential clinical benefits and cost-effectiveness of computed tomography (CT) screening for lung cancer in Hodgkin's lymphoma survivors.
Materials and methods: We developed a Markov decision-analytic model to compare annual low-dose CT screening versus no screening in a hypothetical cohort of patients diagnosed with stage IA–IIB Hodgkin's lymphoma at age 25, with screening starting 5 years after initial diagnosis. We derived model parameters from published studies and the Surveillance, Epidemiology and End Results (SEER) Program, and assumed that stage-shift produces a survival benefit.
Results: Annual CT screening increased survival by 0.64 years for smokers and 0.16 years for non-smokers. The corresponding benefits in quality-adjusted survival were 0.58 quality-adjusted life-years (QALYs) for smokers and 0.14 QALYs for non-smokers. The incremental cost-effectiveness ratios for annual CT screening compared with no screening were $34 100/QALY for smokers and $125 400/QALY for non-smokers.
Conclusions: Our analysis suggests that if early promising results for lung cancer screening hold, CT screening for lung cancer may increase survival and quality-adjusted survival among Hodgkin's lymphoma survivors, with a benefit and incremental cost-effectiveness ratio for smokers comparable to that of other recommended cancer screening strategies.
Key words: cost-effectiveness, decision analysis, Hodgkin's lymphoma, lung cancer, second malignancies
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