Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Carina M. Behr; Maarten J. IJzerman; Michelle M.A. Kip; Harry J.M. Groen; Marjolein A. Heuvelmans; Maarten van den Berge; Pim van der Harst; Marleen Vonder; Rozemarijn Vliegenthart; Hendrik Koffijberg

doi:10.1016/j.jtocrr.2025.100813

Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Carina M. Behr
, Maarten J. IJzerman
, Michelle M.A. Kip
, Harry J.M. Groen
, Marjolein A. Heuvelmans
, Maarten van den Berge
, Pim van der Harst
, Marleen Vonder
, Rozemarijn Vliegenthart
, Hendrik Koffijberg^*

^*Corresponding author for this work

Erasmus School of Health Policy & Management

University of Twente
University Medical Centre Groningen
Utrecht University
University of Groningen

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

39 Downloads (Pure)

Abstract

Introduction:

The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands.

Methods:

A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted.

Results:

Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs.

Conclusions:

Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.

Original language	English
Article number	100813
Journal	JTO Clinical and Research Reports
Volume	6
Issue number	5
DOIs	https://doi.org/10.1016/j.jtocrr.2025.100813
Publication status	Published - May 2025

Bibliographical note

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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1-s2.0-S2666364325000293-mainFinal published version, 1.2 MBLicence: CC BY

Cite this

Behr, C. M., IJzerman, M. J., Kip, M. M. A., Groen, H. J. M., Heuvelmans, M. A., van den Berge, M., van der Harst, P., Vonder, M., Vliegenthart, R., & Koffijberg, H. (2025). Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease. JTO Clinical and Research Reports, 6(5), Article 100813. https://doi.org/10.1016/j.jtocrr.2025.100813

@article{10cf59a045494003a7d40b96ccf8d1f7,

title = "Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease",

abstract = "Introduction: The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands. Methods: A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted. Results: Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs. Conclusions: Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.",

author = "Behr, \{Carina M.\} and IJzerman, \{Maarten J.\} and Kip, \{Michelle M.A.\} and Groen, \{Harry J.M.\} and Heuvelmans, \{Marjolein A.\} and \{van den Berge\}, Maarten and \{van der Harst\}, Pim and Marleen Vonder and Rozemarijn Vliegenthart and Hendrik Koffijberg",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2025",

month = may,

doi = "10.1016/j.jtocrr.2025.100813",

language = "English",

volume = "6",

journal = "JTO Clinical and Research Reports",

issn = "2666-3643",

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}

Behr, CM, IJzerman, MJ, Kip, MMA, Groen, HJM, Heuvelmans, MA, van den Berge, M, van der Harst, P, Vonder, M, Vliegenthart, R & Koffijberg, H 2025, 'Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease', JTO Clinical and Research Reports, vol. 6, no. 5, 100813. https://doi.org/10.1016/j.jtocrr.2025.100813

Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease. / Behr, Carina M.; IJzerman, Maarten J.; Kip, Michelle M.A. et al.
In: JTO Clinical and Research Reports, Vol. 6, No. 5, 100813, 05.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

AU - Behr, Carina M.

AU - IJzerman, Maarten J.

AU - Kip, Michelle M.A.

AU - Groen, Harry J.M.

AU - Heuvelmans, Marjolein A.

AU - van den Berge, Maarten

AU - van der Harst, Pim

AU - Vonder, Marleen

AU - Vliegenthart, Rozemarijn

AU - Koffijberg, Hendrik

PY - 2025/5

Y1 - 2025/5

N2 - Introduction: The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands. Methods: A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted. Results: Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs. Conclusions: Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.

AB - Introduction: The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands. Methods: A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55–74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted. Results: Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs. Conclusions: Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.

UR - https://www.scopus.com/pages/publications/105001487066

U2 - 10.1016/j.jtocrr.2025.100813

DO - 10.1016/j.jtocrr.2025.100813

M3 - Article

C2 - 40236262

AN - SCOPUS:105001487066

SN - 2666-3643

VL - 6

JO - JTO Clinical and Research Reports

JF - JTO Clinical and Research Reports

IS - 5

M1 - 100813

ER -

Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Abstract

Bibliographical note

UN SDGs

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