PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

CT lung screening appears cost-effective

2014-11-06
(Press-News.org) PROVIDENCE, R.I. [Brown University] — A new statistical analysis of results from the National Lung Screening Trial (NLST) concludes that performing low-dose computerized tomography screening can be cost-effective compared to doing no screening for lung cancer in aging smokers.

"This provides evidence, given the assumptions we used, that it is cost-effective," said Ilana Gareen, assistant professor (research) of epidemiology in Brown University's School of Public Health and second author on the new study in the New England Journal of Medicine.

Four years ago, the vast NLST showed that low-dose helical CT scanning reduced mortality from lung cancer by 20 percent compared to chest X-rays. The study involved more than 53,000 smokers aged 55-74. Chest X-rays, meanwhile, have been shown to be no better than doing nothing to screen for the cancer.

With the NLST's trove of medical and cost data to work from, a research team including Gareen, senior author Constantine Gatsonis, professor of biostatistics, and lead author Dr. William Black at Dartmouth College's Geisel School of Medicine, set out to determine the financial implications of conducting CT screening compared to not screening. The standard for this is to calculate a ratio of the costs of CT screening per person — including the test, any follow-up testing and treatment, and indirect costs — and the number of "quality-adjusted life-years added" per person across the population. The quality adjustment distinguishes between living in good health and surviving but with major health problems.

The resulting ratio was $81,000 per quality year added. A standard accepted value is that any sum below $100,000 is cost-effective.

Assumptions and questions

The researchers concluded that, "whether screening outside the trial will be cost-effective will depend on how screening is implemented." This is because, like all cost-effectiveness analyses, the derivation of the $81,000 ratio involved many assumptions. When the researchers varied their assumptions or conducted analyses of cost-effectiveness in some subgroups of patients, they found that the resulting ratios varied widely — sometimes improving but sometimes reducing the cost-effectiveness.

Here's one example: In the main analysis researchers assumed that there was no life-prolonging medical benefit to CT screening other than detecting lung cancer. But when they factored in a different assumption — that other serious conditions would be detected and treated (as happened during the NLST) — then the ratio fell to $54,000 per quality-adjusted life-year added.

They also saw the ratio become more favorable when they assumed that some diagnoses of lung cancer assumed to be "excess" (diagnoses beyond the rate that is expected in the population) were cancers that would have impacted participant life expectancy, as opposed to being benign forms of lung cancer.

But other changes in assumptions brought the ratio above or near the $100,000 cutoff. Examples included adding in the future health costs for survivors, assuming higher costs than in the study for screening, follow-up, or treatment — or more pessimistic assumptions about survival or quality of life. When the cost for the test reached $500 (compared to the $285 it cost in the NLST), then cost-effectiveness eroded.

Another variable factor was the number of CT tests that would be needed to follow-up a positive screening test. A prior paper examining CT lung screening cost-effectiveness assumed four.

"There are additional questions that still need to be investigated," Gareen said, "issues such as how often patients need to be screened, what's the optimal interval, whether screen results should impact future screening requency — i.e., should you wait two years to screen again after a patient has a negative screening exam?"

Among patient subgroups, CT screening was more cost-effective in women than in men and more economical among higher-risk patients than among lower-risk ones, the analysis found.

Ultimately, the study suggests that health care providers will have a substantial impact on whether CT screening proves cost-effective in the complex health care marketplace.

"We estimate that screening with low-dose CT for lung cancer as performed in the NLST costs less than $100,000 per QALY gained," the authors concluded. "The determination of whether screening performed outside the trial will be cost-effective will depend on exactly how screening is implemented."

That matters, Gareen said, because while CT scanning has a demonstrated medical benefit, paying for it means potentially not paying for something else.

"Cost is becoming more and more important, and if you fund one thing, there are other things you won't be able to fund," she said. In addition to Gareen, Gatsonis, and Black, other authors on the paper are Brown researchers JoRean Sicks, Samir Sonegji, Emmett Keeler, Denise Aberle, Arash Naeim, Timothy Church, Gerald Silvestri, and Jeremy Gorelick (formerly of Brown). Also at Brown Stavroula Chrysanthopoulou, Sarah Demello, Prattikumar Desai, and Eric Greco contributed to the analysis.

INFORMATION:

The National Cancer Institute funded the NLST, including this study (grants U01-CA-80098, CA 79778). The study was conducted by the NCI-funded American College of Radiology (ACRIN), now part of the ECOG-ACRIN Cancer Research Group.



ELSE PRESS RELEASES FROM THIS DATE:

More evidence arthritis/pain relieving drugs may contribute to stroke death

2014-11-05
MINNEAPOLIS – Commonly prescribed, older drugs for arthritis and pain may increase the risk of death from stroke, according to a study published in the November 5, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology. Stroke is the fourth leading cause of death in the United States, according to the Centers for Disease Control and Prevention. The drugs examined in the study, called COX-2 inhibitors, include older drugs diclofenac, etodolac, nabumeton and meloxicam, as well as newer drugs called coxibs, including celecoxib ...

For leaders, looking intelligent is less important than looking healthy

For leaders, looking intelligent is less important than looking healthy
2014-11-05
People look for candidates with a healthy complexion when choosing a leader, but don't favor the most intelligent-looking candidates except for positions that require negotiation between groups or exploration of new markets. These results are published in the open-access journal Frontiers in Human Neuroscience. Brian Spisak from the VU University Amsterdam and colleagues studied people's implicit preferences for traits of leaders, such as health, intelligence, and attractiveness, and how they look for information about these qualities in the physical appearance of others. ...

Increase in incidence of colorectal cancer in young adults, rate expected to rise

2014-11-05
While the incidence of colorectal cancer (CRC) in people 50 years or older has declined, the incidence among people 20 to 49 years has increased, according to a report published online by JAMA Surgery. CRC is the third most common cancer among men and women, with an estimated 142,820 new cases and an estimated 50,830 deaths in the United States in 2013. From 1998 through 2006, the incidence of CRC declined 3 percent per year in men and 2.4 percent in women, a decrease largely attributed to an increase in screening, which is recommended for all adults over 50 years old. ...

Safest cosmetic surgery procedures

2014-11-05
First large prospective study to analyze rate of adverse events No risk of serious adverse events, less than 1 percent minor problems Fillers, neurotoxins, laser, energy device procedures exceedingly safe Minimally invasive cosmetic procedures can be mixed to give significant cosmetic boost CHICAGO --- Minimally invasive cosmetic procedures, including fillers, neurotoxins and laser and energy device procedures are exceedingly safe and have essentially no risk of serious adverse events, reports a new Northwestern Medicine® study that analyzed more than 20,000 procedures ...

Few adverse events found in noninvasive, minimally invasive cosmetic procedures

2014-11-05
A tiny fraction of adverse events occurred after dermatologists performed more than 20,000 noninvasive and minimally invasive cosmetic procedures, according to a study published online by JAMA Dermatology. Cosmetic dermatology is a well-developed field and data suggest the procedures are associated with a low rate of adverse events, according to background information in the study. Researcher Murad Alam, M.D., M.S.C.I., of the Feinberg School of Medicine at Northwestern University, Chicago, and co-authors characterized the incidence of adverse events associated with ...

Analyzing heat waves -- new index allows predicting their magnitude

2014-11-05
JRC scientists have developed a new index to measure the magnitude of heat waves, in cooperation with colleagues from five research organisations. According to the index projections, under the worst climate scenario of temperature rise nearing 4.8⁰C, extreme heat waves will become the norm by the end of the century. Heat waves like the one that hit Russia in summer 2010, the strongest on record in recent decades, will occur as often as every two years in southern Europe, North and South America, Africa and Indonesia. The Heat Wave Magnitude Index is the first to ...

Young patients with newly diagnosed colorectal cancer anticipated to nearly double by 2030

2014-11-05
November 5, 2014 – In the next 15 years, more than one in 10 colon cancers and nearly one in four rectal cancers will be diagnosed in patients younger than the traditional screening age, according to researchers at The University of Texas MD Anderson Cancer Center. This growing public health problem is underscored by data trends among 20- to 34-year-olds in the U.S., among whom the incidence of colon and rectal cancer (CRC) is expected to increase by 90% and 124.2%, respectively, by 2030. Published in the current issue of JAMA Surgery, the findings build on prior ...

The female nose always knows: Do women have more olfactory neurons?

The female nose always knows: Do women have more olfactory neurons?
2014-11-05
Rio de Janeiro, Brazil -Individuals show great diversity in their ability to identify scents and odors. More importantly, males and females greatly differ in their perceptual evaluation of odors, with women outperforming men on many kinds of smell tests. Sex differences in olfactory detection may play a role in differentiated social behaviors and may be connected to one's perception of smell, which is naturally linked to associated experiences and emotions. Thus, women's olfactory superiority has been suggested to be cognitive or emotional, rather than perceptual. ...

Allina Health heart procedure complications reduced with simple tool

2014-11-05
MINNEAPOLIS – (November 5, 2014) – Every year in the U.S., 600,000 heart procedures are performed by threading thin tubes through patients' arteries to access their hearts. Percutaneous coronary intervention – or PCI – is an alternative to open heart surgery for many common heart problems. But bleeding from the insertion site from blood thinners used during the procedure is a common complication of PCI, occurring two to six percent of the time. "That might not sound serious, but bleeding is associated with adverse events, including death," said ...

Having a Y chromosome doesn't affect women's response to sexual images, brain study shows

2014-11-05
Women born with a rare condition that gives them a Y chromosome don't only look like women physically, they also have the same brain responses to visual sexual stimuli, a new study shows. The journal Hormones and Behavior published the results of the first brain imaging study of women with complete androgen insensitivity, or CAIS, led by psychologists at Emory. "Our findings clearly rule out a direct effect of the Y chromosome in producing masculine patterns of response," says Kim Wallen, an Emory professor of psychology and behavioral neuroendocrinology. "It's further ...

LAST 30 PRESS RELEASES:

Program takes aim at drinking, unsafe sex, and sexual assault on college campuses

Inability to pay for healthcare reaches record high in U.S.

Science ‘storytelling’ urgently needed amid climate and biodiversity crisis

KAIST Develops Retinal Therapy to Restore Lost Vision​

Adipocyte-hepatocyte signaling mechanism uncovered in endoplasmic reticulum stress response

Mammals were adapting from life in the trees to living on the ground before dinosaur-killing asteroid

Low LDL cholesterol levels linked to reduced risk of dementia

Thickening of the eye’s retina associated with greater risk and severity of postoperative delirium in older patients

Almost one in ten people surveyed report having been harmed by the NHS in the last three years

Enhancing light control with complex frequency excitations

New research finds novel drug target for acute myeloid leukemia, bringing hope for cancer patients

New insight into factors associated with a common disease among dogs and humans

Illuminating single atoms for sustainable propylene production

New study finds Rocky Mountain snow contamination

Study examines lactation in critically ill patients

UVA Engineering Dean Jennifer West earns AIMBE’s 2025 Pierre Galletti Award

Doubling down on metasurfaces

New Cedars-Sinai study shows how specialized diet can improve gut disorders

Making moves and hitting the breaks: Owl journeys surprise researchers in western Montana

PKU Scientists simulate the origin and evolution of the North Atlantic Oscillation

ICRAFT breakthrough: Unlocking A20’s dual role in cancer immunotherapy

How VR technology is changing the game for Alzheimer’s disease

A borrowed bacterial gene allowed some marine diatoms to live on a seaweed diet

Balance between two competing nerve proteins deters symptoms of autism in mice

Use of antifungals in agriculture may increase resistance in an infectious yeast

Awareness grows of cancer risk from alcohol consumption, survey finds

The experts that can outsmart optical illusions

Pregnancy may reduce long COVID risk

Scientists uncover novel immune mechanism in wheat tandem kinase

Three University of Virginia Engineering faculty elected as AAAS Fellows

[Press-News.org] CT lung screening appears cost-effective