OneFlorida researchers plan to evaluate cost-effectiveness of lung cancer screening

Photo of lung cancer screening with low-dose CT scan
Annual lung cancer screenings with low-dose computed tomography, or LDCT, can reduce lung cancer mortality by 20% in high-risk patients.

Screening for lung cancer with low-dose CT scans saves lives. But some people who undergo the recommended annual screenings may have to pay a higher price than others for peace of mind.

According to OneFlorida researcher Jiang Bian, Ph.D., associate professor in the department of health outcomes and biomedical informatics (HOBI) at UF Health, annual lung cancer screenings with low-dose computed tomography, or LDCT, can reduce lung cancer mortality by 20% in adults ages 55 to 80 who currently smoke or who once were heavy smokers.

However, the LDCT screening test also has a high rate of false-positive results, erroneously suggesting that lung cancer is present in people who don’t have it. As a result, some people may have to be monitored more frequently with additional periodic tests. Others may have to undergo invasive procedures, such as a lung biopsy, to rule out lung cancer.

“These additional tests add to the cost of screening, increase patient anxiety and may expose some people to unnecessary health risks from the follow-up tests and surgeries,” Bian said.

Bian and HOBI Assistant Professor Yi Guo, Ph.D., are co-principal investigators of a 4-year, $1,467,265 grant from the National Cancer Institute (NCI) to evaluate the benefits, risks and cost-effectiveness of LDCT lung cancer screening—particularly the long-term costs associated with false-positive results.

Until 2011, when the NCI reported that annual LDCT screenings could help reduce lung cancer deaths, no effective screening tests were available for lung cancer, which is the leading cause of cancer deaths in the United States.

The U.S. Preventive Services Task Force now recommends annual lung cancer screenings with LDCT for people who are between 55 and 80 years old with a history of heavy smoking and who smoke now or have quit within the past 15 years. Heavy smokers are those who smoke an average of one pack or more of cigarettes per day for a year or longer.

The researchers estimate that about 11 million Americans are eligible for lung cancer screening with LDCT.

“One important difference between this study and previous ones is that we will use data from real-world settings in Florida to examine the benefits, risks and costs of lung cancer screening with LDCT,” Bian said.

Some researchers and policy-makers have raised concerns that the false positive rate—reported as 23.3% in the original National Lung Screening Trial (NLST)—may be even higher in real-world clinical settings than in controlled clinical trials taking place in well-established facilities with proficiency in cancer care.

The research team will use data from the OneFlorida Clinical Research Consortium, a large repository of linked electronic health records, administrative claims and cancer registry data covering more than 50% of patients in Florida across all 67 counties. The team will examine lung cancer screening usage trends, predictors of appropriate and inappropriate use, the impact of screening on long-term survival, costs associated with the test’s high rate of false positive results, and cost-effectiveness of screenings.

Other members of the research team include HOBI assistant professors Yonghui Wu, Ph.D., and Ramzi Salloum, Ph.D.; Michelle Alvarado, Ph.D., in the UF College of Engineering’s department of industrial and systems engineering; and Hiren Mehta, M.D., associate professor of medicine, vice chief of clinical affairs, program director of the Interventional Pulmonary Fellowship Program, and clinical leader for the lung cancer group in the UF College of Medicine’s Division of Pulmonary, Critical Care and Sleep Medicine.

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