Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: a registry study

Jakob F Rasmussen; Volkert Siersma; Jesper H Pedersen; Bruno Heleno; Zaigham Saghir; John Brodersen

doi:10.1016/j.lungcan.2013.12.005

Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: a registry study

Lung Cancer. 2014 Mar;83(3):347-55. doi: 10.1016/j.lungcan.2013.12.005. Epub 2013 Dec 30.

Authors

Jakob F Rasmussen¹, Volkert Siersma², Jesper H Pedersen³, Bruno Heleno², Zaigham Saghir³, John Brodersen²

Affiliations

¹ The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark. Electronic address: jakobra@sund.ku.dk.
² The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
³ Department of Cardiothoracic Surgery, RT 2152, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.

PMID: 24418526
DOI: 10.1016/j.lungcan.2013.12.005

Abstract

Objectives: Low dose computerised tomography (CT) screening for lung cancer can reduce lung-cancer-specific mortality. The objective of this study was to analyse healthcare costs and healthcare utilisation of participants in the Danish lung cancer CT-screening trial (DLCST).

Materials and methods: This registry study was nested in a randomised controlled trial (DLCST). 4104 participants, current or former heavy smokers, aged 50-70 years were randomised to five annual low dose CT scans or usual care during 2004-2010. Total healthcare costs and healthcare utilisation data for both the primary and the secondary healthcare sector were retrieved from public registries from randomisation - September 2011 and compared between (1) the CT-screening group and the control group and, (2) the control group and each of the true-positive, false-positive and true-negative groups.

Results: The median annual costs per participant were significantly higher in the CT-screening group (Euros [EUR] 1342, interquartile range [IQR] 750-2980) compared with the control group (EUR 1190, IQR 590-2692) (p<0.0001). When the cost of the CT-screening programme was excluded, there was no longer a statistically significant difference between the CT-screening group (EUR 1155, IQR 567-2798) and the control group (p=0.52). Analyses according to the diagnostic groups showed that annual costs were 10.57 (95% CI 7.09-15.75) times higher for the true-positive and 1.67 (95% CI 1.20-2.32) times higher for the false-positive group compared with the control group.

Conclusion: Low dose lung cancer CT screening increases healthcare costs compared with no screening; this difference was attributable to the costs of the CT-screening programme. Overall healthcare costs were higher for the true-positive and false-positive groups than for the control group, also when excluding the cost of the CT-screening programme. This increase was outweighed by the larger true-negative group showing no significant differences in costs compared with the control group.

Keywords: Cancer early detection; Cancer screening test; Healthcare cost; Lung cancer; Mass screening; Scan spiral CT.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Denmark
Early Detection of Cancer
Female
Health Care Costs / statistics & numerical data*
Humans
Lung Neoplasms / diagnosis
Lung Neoplasms / epidemiology*
Male
Mass Screening
Middle Aged
Registries*
Tomography, X-Ray Computed*