Modelling the cost-effectiveness of early awareness interventions for the early detection of lung cancer

<p dir="ltr">The calibrated natural history model provides a range of estimates about the incidence and progression of pre-clinical NSCLC in England. It suggests that there is likely to be a significant population in England with early pre-clinical disease (roughly 75,000 with stage I or II who have not been clinically diagnosed with the disease) who are very unlikely to experience progression to a more severe disease state or to be clinically identified. Furthermore, the model confirms clinical understanding that, in many cases, once early stage NSCLC progresses to a more severe state it can do so very rapidly. This suggests the importance of early clinical identification to enable early treatment before progression.</p><p dir="ltr">Application of the observed shift in the stage of disease at diagnosis from the NAEDI pilot (adjusting for the shift in the control area) using base-case assumptions results in an early awareness programme generating additional quality adjusted survival (325 quality-adjusted life years (QALYs)) but at an additional cost to the NHS in terms of diagnostic and treatment costs (£1 million) alongside to the cost of the media campaign (£2.9 million). Taken together, improved outcomes but increased costs results in an incremental cost-effectiveness ratio of £12,192 (i.e. the extra additional cost per quality adjusted life-year gained). This would suggest that, using the National Institute for Health and Clinical Excellence (NICE) cost-effectiveness threshold of between £20,000 and £30,000 per QALY, a national campaign aiming to increase the early awareness of the signs and symptoms of NSCLC would be cost-effective.</p><p dir="ltr">The first alternative scenario found that the campaign would no longer be cost-effective if the additional costs of the increase in ‘worried well’ patients were to be greater than £2.5 million (assuming a cost effectiveness threshold of £20,000 per QALY). Under the assumption that 50% of such patients would be given chest x-rays this would require 35,799 worried well individuals to attend their GP as a result of the campaign for that campaign to cease to be cost effective. The second alternative scenario found that a cost saving of £3.9 million associated with a shift in the route of diagnosis away from emergency admission and towards presentation at GP clinics, would imply a national campaign was both cost-saving to the NHS and health improving.</p>