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Tanner J Caverly



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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.11-15 - Identifying Patients for Whom Lung Cancer Screening is Preference-Sensitive: A Microsimulation Study (ID 12433)

      16:45 - 18:00  |  Author(s): Tanner J Caverly

      • Abstract

      Background

      Background: Many health systems are still exploring how to implement an effective, patient-centered low-dose computed tomography (LDCT) screening program.

      Objective: Examine factors that influence when LDCT screening is preference-sensitive.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Design: State-transition microsimulation model

      Data Sources: Two large randomized trials, published decision analyses, and the Surveillance, Epidemiology and End-Results cancer registry

      Target Population: US-representative sample of simulated patients meeting current US Preventive Services Task Force screening eligibility criteria

      Time Horizon: Lifetime

      Perspective: Individual

      Intervention: LDCT screening annually for 3 years

      Outcomes Measures: Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, we varied disutilities (i.e., negative feelings) quantifying the burden of screening and follow-up across a likely range. We also examined the effect of varying the rate of false-positive scans and overdiagnosis associated with screening.

      4c3880bb027f159e801041b1021e88e8 Result

      Results of Base-Case Analysis: Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with < 0.3% annual lung cancer risk or life-expectancy < 10.5 years. For higher-risk eligible persons with longer life-expectancy, roughly 50% of the study population, LDCT screening overcame even highly negative views about screening and its downsides.

      Results of Sensitivity Analysis: Rates of false-positive findings and overdiagnosed lung cancers were not highly influential.

      Limitation: The quantitative thresholds we identified may vary depending on the structure of the microsimulation model.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusions: Identifying circumstances under which LDCT screening is more vs. less preference-sensitive may help clinicians personalize their approach to discussing LDCT screening, tailoring to both preferences and clinical benefit.

      THIS ARTICLE HAS BEEN ACCEPTED FOR PUBLICATION IN THE ANNALS FOR INTERNAL MEDICINE. Given its relevance, we would like the opportunity to present our findings at the WCLC

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