2011 ACRIN Annual Meeting Cost-Effectiveness of Screening in the National Lung Screening Trial William C. Black, MD Dartmouth-Hitchcock Medical Center

2011 ACRIN Annual Meeting Working Group

2011 ACRIN Annual Meeting NLST CEA Comparison: LDCT vs CXR vs None Effectiveness: LYs and QALYs Costs: $US (reference 2009) Perspective: Societal Time horizon: Within-trial and lifetime Discount rate: 3%.

2011 ACRIN Annual Meeting Effectiveness Aggregate LYs from entry to death Observed survival before 2009 Projected survival after 2009 –age, sex, lung ca stage, smoking

2011 ACRIN Annual Meeting Effectiveness (cont) Adjust LYs for QOL (0-1.0) SF-6D utility scoring Estimate missing scores –age, sex, scr, lung ca Brazier et al. JHE 2002; 21:271-92

2011 ACRIN Annual Meeting Costs Direct medical (screening, dx, rx) Non-medical (travel, lodging) Opportunity (lost wages) Projected beyond age, sex, and lung ca stage

2011 ACRIN Annual Meeting Direct Medical Costs Utilization based on med abstraction Estimate/ impute missing utilization Multiply by Medicare prices

2011 ACRIN Annual Meeting ICER = ∆COSTS ∆QALYS

2011 ACRIN Annual Meeting Baseline Results LYs, QALYs & Costs ICERs Subset analyses –age, sex, smok hx, co-morbidity

2011 ACRIN Annual Meeting Hypothetical Baseline Results

2011 ACRIN Annual Meeting Uncertainty Sensitivity analysis Scatter plot of ICE CE Acceptability curves

2011 ACRIN Annual Meeting Incremental Cost Incremental Effect IIIB IV IIIA IA IIIB K Black WC. Med Decis Making 1990;10:212-4

2011 ACRIN Annual Meeting Accomplishments Developed analytic approach using R Completed analysis of “enriched” DHMC subset Developed plan for managing missing data Obtained approval to reuse Medicare data Developed algorithms for projecting survival Selected relevant CPT and DRG codes.

2011 ACRIN Annual Meeting Next Steps Estimate Medicare payments for DRGs Extract utilization and QOL from ACRIN dataset Analyze Medicare data & adjust cost estimates Impute and/or estimate missing data elements Analyze completed NLST CEA dataset in R Write up results and submit.

2011 ACRIN Annual Meeting Use this slide for graphics or images requiring a larger space

2011 ACRIN Annual Meeting Use this slide for text only Keep number of points to six of fewer per slide