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Quantifying The Value of Reduced Health Disparities: Low-Dose CT Lung Cancer Screening of High-Risk Individuals within the US.

  • Shafrin, Jason1
  • Kim, Jaehong2
  • Marin, Moises3
  • Ramsagar, Sangeetha4
  • Davies, Mark Lloyd5
  • Stewart, Kyana6
  • Kalsekar, Iftekhar7
  • Vachani, Anil8
  • 1 Center Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA, USA. Electronic address: [email protected].
  • 2 Center Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA, USA.
  • 3 Center for Healthcare Economics and Policy, FTI Consulting, District of Columbia, DC, USA.
  • 4 Strategic Business Transformation & Lung Cancer Initiative, Johnson and Johnson, Raritan, NJ, USA.
  • 5 WW Govt Affairs & Policy & Lung Cancer Initiative, Johnson and Johnson, High Wycombe, UK.
  • 6 DePuy Synthes, Johnson & Johnson, Warsaw, IN, US.
  • 7 Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, US.
  • 8 University of Pennsylvania, Philadelphia, PA, US. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, US.
Published Article
Value in Health
Publication Date
Jan 06, 2024
DOI: 10.1016/j.jval.2023.12.014
PMID: 38191024


To measure the value of increasing lung cancer screening rates for high-risk individuals and its impact on health disparities. The model estimated changes in health economic outcomes if low-dose computed tomography (LDCT) screening increased from current to 100% compliance, following clinical guidelines. Current LDCT screening rates were estimated by income, education and race, using 2017-2019 Behavioral Risk Factor Surveillance System data. The model contained a decision tree module to segment the population by screening outcomes and a Markov chain module to estimate cancer progression over time. Model parameters included information on survival, quality-of-life, and costs related to cancer diagnosis, treatment, and adverse events. Distributional cost-effectiveness analysis (DCEA) estimated the net monetary value from reduced health disparities-measured using quality adjusted life expectancy (QALE)-across income, education and race groups. Outcomes were assessed over 30 years. Lung cancer screening eligibility using US Preventative Services Task Force (USPSTF) guidelines was higher for individuals with income <$15,000 (47.2%) and without a high-school education (46.1%), compared to individuals with income >$50,000 (16.6%) and with a college degree (13.5%), respectively. Increasing lung cancer screening to 100% compliance was cost-effective ($64,654 per QALY) and produced economic value by up to $560 per person ($182.1 billion for US overall). Up to 32.2% of the value was due to reductions in health disparities. Significant value in increasing lung cancer screening rates derived from reducing health disparities. Policymakers and clinicians may not be appropriately prioritizing cancer screening if value from reducing health disparities are unconsidered. Copyright © 2024 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. All rights reserved.

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