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  P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27613

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    P3.11-03 - Implementing Lung Cancer Screening in Canada: Evidence on Adherence and Budget Impact from the Pan-Canadian Early Detection Study (ID 13417)

    12:00 - 13:30  |  Author(s): Stuart James Peacock
    • Abstract

    Background
    

    High-risk lung cancer screening has favourable cost-effectiveness ratios; making it an attractive intervention for lung cancer control. Relatively little is known, however, about the implementation of lung cancer screening in universal health care systems. To address this, we characterize screening adherence rates in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan) and prepare a budget impact analysis for Canada.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We retrospectively characterized screening adherence to short-term (first-year) and long-term (year-four) annual screening rounds in the PanCan study and explored association with socio-demographic and screening characteristics with logistic regression models and Mann-Whitney rank sum and Chi square likelihood tests. We did a four-year budget impact analysis using published utilization rates for screening-related and incidental healthcare resources, smoking cessation, opportunistic screening and projected market dynamics for entrant treatments in Canada.

    4c3880bb027f159e801041b1021e88e8 Result
    

    The PanCan study screened 2537 participants with a baseline LDCT exam; of these, 2254 (88.9%) adhered to the second annual screening exam and 1,762 (69.5%) adhered to the year four exam. After adjusting for lung cancer incidences and other-cause mortality, we found significant associations between self-reported “current smoker” status and lower, second annual scan adherence rates (p<0.05); while variables related to the delivery of the intervention—such as the use of screening autofluorescence bronchoscopy and finding a lung nodule on the baseline LDCT—were significantly associated with greater adherence (p<0.05). Adherence to year-four screening exams was positively associated with age, family history of lung cancer, baseline quality of life and prior screening exam adherence (all p<0.05). Non-adherence was significantly associated with participants who had greater than 100 pack-years of smoking history and a lower level of formal education (p<0.05). Compared to participants who adhered to their scheduled, year-four annual screening exams, non-adherent participants had a higher predicted risk of developing lung cancer at baseline (p<0.05). The budget impact analysis indicates that the incremental program costs for screening an estimated 257, 914 eligible, high-risk, Canadians would be highly favourable compared to selection based on age and smoking history alone. The budget impact was also sensitive to uncertainty around the cost to treat actionable incidental findings and the adoption of entrant systemic therapy drugs.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Study participants who were at the highest risk of developing lung cancer, were the least likely to adhere to screening. Using risk selection would enable affordable programs; however, programs may be compromised by barriers to participation for individuals who are at the greatest risk of developing lung cancer.

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