Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study

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Abstract

Background:

Many health systems are exploring how to implement low-dose computed tomography (LDCT) screening programs that are effective and patient-centered.

Objective:

To examine factors that influence when LDCT screening is preference-sensitive.

Design:

State-transition microsimulation model.

Data Sources:

Two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Target Population:

U.S.-representative sample of simulated patients meeting current U.S. Preventive Services Task Force criteria for screening eligibility.

Time Horizon:

Lifetime.

Perspective:

Individual.

Intervention:

LDCT screening annually for 3 years.

Outcome Measures:

Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, disutilities (the “degree of dislike”) quantifying the burden of screening and follow-up were varied across a likely range. The effect of varying the rate of false-positive screening results and overdiagnosis associated with screening was also examined.

Results of Base-Case Analysis:

Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides.

Results of Sensitivity Analysis:

Rates of false-positive findings and overdiagnosed lung cancer were not highly influential.

Limitation:

The quantitative thresholds that were identified may vary depending on the structure of the microsimulation model.

Conclusion:

Identifying circumstances in which LDCT screening is more versus less preference-sensitive may help clinicians personalize their screening discussions, tailoring to both preferences and clinical benefit.

Primary Funding Source:

None.

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