Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis
Objective There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with...
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| Format: | Article |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e037145.full |
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| author | Sue Crengle Giorgi Kvizhinadze Melissa McLeod Peter Sandiford Karen Bartholomew |
| author_facet | Sue Crengle Giorgi Kvizhinadze Melissa McLeod Peter Sandiford Karen Bartholomew |
| author_sort | Sue Crengle |
| collection | DOAJ |
| description | Objective There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years.Design A Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets.Setting New Zealand.Participants Population aged 55–74 years in 2011.Interventions Biennial LDCT screening for lung cancer compared with usual care.Outcome measures Incremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and ‘health-adjusted life expectancy’ (HALE) were measured.Results LDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival.Conclusion A national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival. |
| format | Article |
| id | doaj-art-50c7b7d66b8444b1a04f04e2009c2ab0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-50c7b7d66b8444b1a04f04e2009c2ab02025-01-09T03:40:09ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-037145Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysisSue Crengle0Giorgi Kvizhinadze1Melissa McLeod2Peter Sandiford3Karen Bartholomew4Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand1 Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New ZealandTe Rōpū Rangahau Hauora a Eru Pōmare, University of Otago Wellington, Wellington, New ZealandWaitemata District Health Board, Takapuna, New ZealandWaitemata District Health Board, Takapuna, New ZealandObjective There are large inequities in the lung cancer burden for the Indigenous Māori population of New Zealand. We model the potential lifetime health gains, equity impacts and cost-effectiveness of a national low-dose CT (LDCT) screening programme for lung cancer in smokers aged 55–74 years with a 30 pack-year history, and for formers smokers who have quit within the last 15 years.Design A Markov macrosimulation model estimated: health benefits (health-adjusted life-years (HALYs)), costs and cost-effectiveness of biennial LDCT screening. Input parameters came from literature and NZ-linked health datasets.Setting New Zealand.Participants Population aged 55–74 years in 2011.Interventions Biennial LDCT screening for lung cancer compared with usual care.Outcome measures Incremental cost-effectiveness ratios were calculated using the average difference in costs and HALYs between the screened and the unscreened populations. Equity analyses included substituting non-Māori values for Māori values of background morbidity, mortality and stage-specific survival. Changes in inequities in lung cancer survival and ‘health-adjusted life expectancy’ (HALE) were measured.Results LDCT screening in NZ is likely to be cost-effective for the total population: NZ$34 400 per HALY gained (95% uncertainty interval NZ$27 500 to NZ$42 900) and for Māori separately (using a threshold of gross domestic product per capita NZ$45 000). Health gains per capita for Māori females were twice that for non-Māori females and 25% greater for Māori males compared with non-Māori males. LDCT screening will narrow absolute inequities in HALE and lung cancer mortality for Māori, but will slightly increase relative inequities in mortality from lung cancer (compared with non-Māori) due to differential stage-specific survival.Conclusion A national biennial LDCT lung cancer screening programme in New Zealand is likely to be cost-effective, will improve total population health and reduce health inequities for Māori. Attention must be paid to addressing ethnic inequities in stage-specific lung cancer survival.https://bmjopen.bmj.com/content/10/9/e037145.full |
| spellingShingle | Sue Crengle Giorgi Kvizhinadze Melissa McLeod Peter Sandiford Karen Bartholomew Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis BMJ Open |
| title | Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis |
| title_full | Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis |
| title_fullStr | Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis |
| title_full_unstemmed | Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis |
| title_short | Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis |
| title_sort | impact of low dose ct screening for lung cancer on ethnic health inequities in new zealand a cost effectiveness analysis |
| url | https://bmjopen.bmj.com/content/10/9/e037145.full |
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