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

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.

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.

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.