Benchmarking lung cancer screening programmes with adaptive screening frequency against the optimal screening schedules derived from the ENGAGE framework: a comparative microsimulation study

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dc.citation.articleNumber102743en_US
dc.citation.journalTitleeClinicalMedicineen_US
dc.citation.volumeNumber74en_US
dc.contributor.authorHemmati, Mehdien_US
dc.contributor.authorIshizawa, Sayakaen_US
dc.contributor.authorMeza, Rafaelen_US
dc.contributor.authorOstrin, Edwinen_US
dc.contributor.authorHanash, Samir M.en_US
dc.contributor.authorAntonoff, Maraen_US
dc.contributor.authorSchaefer, Andrew J.en_US
dc.contributor.authorTammemägi, Martin C.en_US
dc.contributor.authorToumazis, Iakovosen_US
dc.date.accessioned2024-08-09T16:25:24Zen_US
dc.date.available2024-08-09T16:25:24Zen_US
dc.date.issued2024en_US
dc.description.abstractBackground Lung cancer screening recommendations employ annual frequency for eligible individuals, despite evidence that it may not be universally optimal. The impact of imposing a structure on the screening frequency remains unknown. The ENGAGE framework, a validated framework that offers fully dynamic, analytically optimal, personalised lung cancer screening recommendations, could be used to assess the impact of screening structure on the effectiveness and efficiency of lung cancer screening. Methods In this comparative microsimulation study, we benchmarked alternative clinically relevant structured lung cancer screening programmes employing a fixed (annual or biennial) or adaptive (start with annual/biennial screening and then switch to biennial/annual at ages 60- or 65-years) screening frequency, against the ENGAGE framework. Individuals were eligible for screening according to the 2021 US Preventive Services Task Force recommendation on lung cancer screening. We assessed programmes' efficiency based on the number of screenings per death avoided (LDCT/DA) and the number of screenings per ever-screened individual (LDCT/ESI), and programmes’ effectiveness using quality-adjusted life years (QALY) gained from screening, lung cancer-specific mortality reduction (MR), and number of screen-detected lung cancer cases. We used validated natural history, smoking history generator, and risk prediction models to inform our analysis. Sensitivity analysis of key inputs was conducted. Findings ENGAGE was the best performing strategy. Among the structured policies, adaptive biennial-to-annual at age 65 was the best strategy requiring 24% less LDCT/DA and 60% less LDCT/ESI compared to TF2021, but yielded 105 more deaths per 100,000 screen-eligible individuals (10.2% vs. 11.8% MR for TF2021, p = 0.28). Fixed annual screening was the most effective strategy but the least efficient and was ranked as the fifth best strategy. All strategies yielded similar QALYs gained. Adherence levels did not affect the rankings. Interpretation Adaptive lung cancer screening strategies that start with biennial and switch to annual screening at a prespecified age perform well and warrant further consideration, especially in settings with limited availability of CT scanners and radiologists. Funding National Cancer Institute.en_US
dc.identifier.citationHemmati, M., Ishizawa, S., Meza, R., Ostrin, E., Hanash, S. M., Antonoff, M., Schaefer, A. J., Tammemägi, M. C., & Toumazis, I. (2024). Benchmarking lung cancer screening programmes with adaptive screening frequency against the optimal screening schedules derived from the ENGAGE framework: A comparative microsimulation study. eClinicalMedicine, 74. https://doi.org/10.1016/j.eclinm.2024.102743en_US
dc.identifier.digitalPIIS2589537024003225en_US
dc.identifier.doihttps://doi.org/10.1016/j.eclinm.2024.102743en_US
dc.identifier.urihttps://hdl.handle.net/1911/117627en_US
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.rightsExcept where otherwise noted, this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND) license.  Permission to reuse, publish, or reproduce the work beyond the terms of the license or beyond the bounds of fair use or other exemptions to copyright law must be obtained from the copyright holder.en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en_US
dc.titleBenchmarking lung cancer screening programmes with adaptive screening frequency against the optimal screening schedules derived from the ENGAGE framework: a comparative microsimulation studyen_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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