HTA on screening of lung cancer in risk groups by the Austrian Institute for HTA

The Austrian Institute for Health Technology Assessment (AIHTA) completed a research project, “Lung cancer screening in risk groups systematic reviews of effectiveness and utility (part 1) and costs and budgetary consequences (part 2),” and published the reports in the middle of December 2020.

The aim of the project was to summarize the clinical evidence on lung cancer screening for risk groups and to obtain an overview of the elements of relevant costs, as reported in publications on health economic evaluations, and thus to provide decision support for/against lung cancer screening to be developed in Austria.

The following research questions were studied in Part 1:

• FF1: What is the benefit/risk of screening for lung cancer using low-dose computed tomography (LDCT) compared to no screening in people with an increased risk of lung cancer?
• FF2: What is the benefit/risk of screening for lung cancer with biomarkers in addition to LDCT compared to screening with LDCT alone in people with an increased risk of lung cancer?
• FF3: What is the benefit/risk of annual screening/systematic screening for lung cancer compared to screening with longer intervals (2 years or longer)/opportunistic screening in people with an increased risk of lung cancer?
• FF4: What is the best strategy to inform and/or maximize participation in lung cancer screening for individuals in the target audience?

The following research questions were studied in Part 2:

• FF5: What are the main factors that make up the costs in available health economic evaluations on lung cancer screening?
• FF6: What methods are used in the literature to estimate the costs of lung cancer screening? How are these methods to be assessed critically?
• FF7: What are the results of the available health economic studies in regard to cost-effectiveness and budgetary consequences?

Part 1 of the project is based on the EUnetHTA assessment report on lung cancer screening in risk groups. Based on the evidence from eight randomized controlled trials, it was shown that screening for lung cancer with LDCT in (former) heavy smokers probably reduces lung cancer mortality but results in little or no difference in overall mortality, compared with no screening. For risk groups other than (former) heavy smokers, no studies investigating lung cancer screening using LDCT compared to no screening could be identified. Insufficient evidence is available to answer the research question, whether one specific strategy in lung cancer screening is favorable compared to other screening strategies or whether to use another screening interval than one year. Furthermore, no evidence from RCTs is currently available for the use of biomarkers as an adjunct to LDCT in lung cancer screening.

Fifteen studies (five RCTs, three observational studies, and seven uncontrolled pre-post intervention studies) were included from the systematic literature search to evaluate the best strategy on how to inform individuals in the target group about a lung cancer screening program to optimize informed choices regarding participation. Overall, the current evidence is not sufficient to assess the effectiveness of a particular information or invitation strategy for lung cancer screening. Moderate to a low quality of evidence shows that the use of decision aids prior to LDCT scan (compared to standard information materials) in the context of a lung cancer screening program probably increases a) the knowledge about benefits and harms of lung cancer screening, b) informed decision-making and c) the participant empowerment regarding a decision on lung cancer screening participation.

Part 2 of the project consisted of a systematic literature review of international studies reporting on the cost-effectiveness, cost-utility and/or budget impact of lung cancer screening using LDCT was performed in six databases for the second part of the project.

The results showed that lung cancer screening is a cost-intensive intervention, and introducing it on a population level would depend on its likely budget impact and cost-effectiveness. Given the considerable variation in the study methodology and cost-effectiveness results of the analyzed studies, it is currently not possible to make contentions about the potential cost-effectiveness of LDCT lung cancer screening. For this reason, an economic evaluation and a simultaneous assessment of the national willingness to pay are recommended for the Austrian context.

The full details in German can be found here.

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