Oncology · Public Health · 3 h ago
Model compares risk-based lung cancer screening strategies in Singapore
A lifetime Markov model compared risk-based low-dose CT (LDCT) screening with conventional screening and no screening in Singaporean smokers and never-smokers with a family history of lung cancer. The analysis found that age, sex and screening frequency affected estimated health gains and cost-effectiveness; the authors say further research is needed before implementation.
- Model evaluated LDCT strategies by risk, age and frequency.
- Age-50 annual screening maximized modeled gains among smokers.
- Conventional LDCT was not cost-effective for never-smokers with family history.
- Further research is needed before implementation.
Researchers used a lifetime Markov model to assess LDCT screening strategies for Singaporean smokers and never-smokers with a family history of lung cancer, stratified by sex. Strategies varied by starting age (50, 55 or 60 years) and screening interval (annual, biennial or triennial). A local risk prediction model informed eligibility thresholds. Costs and quality-adjusted life-years (QALYs) were assessed against conventional age- and smoking-based screening and no screening, using willingness-to-pay thresholds of SGD 45,000–75,000 per QALY.
For smokers, annual risk-based screening from age 50 produced the largest estimated QALY gains versus no screening: 0.201 for males and 0.198 for females. Screening from age 60 was more economically efficient, with estimated incremental cost-effectiveness ratios of SGD 40,155 and SGD 42,666 per QALY, respectively. Among never-smokers with a family history, conventional LDCT was not cost-effective in the model. Less intensive strategies from age 60 were more economically efficient than strategies maximizing QALY gains, although results varied by sex.
These are model-based estimates, not evidence that risk-based screening improves outcomes in practice. Findings depend on Singapore-specific inputs and willingness-to-pay assumptions; the authors note that further research is needed to support implementation.
In practice
This Singapore-based model suggests that LDCT eligibility and screening intervals could be tailored by predicted risk, age and sex, including for never-smokers with a family history of lung cancer. It does not establish that these strategies improve clinical outcomes or should replace current screening approaches: the estimates depend on modeled assumptions, local costs and willingness-to-pay thresholds. The authors state that further research is needed before implementation, so the results are informative for policy and study design rather than a basis for changing screening practice.
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BMC Medicine: Optimizing precision lung cancer screening using willingness-to-pay–anchored risk eligibility thresholds ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.