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Capstone Paper Sample

Cost-Benefit Analysis of Low-Dose Computerized Tomography for Frequent Tobacco Users

CHAPTER 1: INTRODUCTION

Background

According to Black et al. (2014), the LCT screening have been stated by the National Lung Screening Trial (NLST) to have adverse effects. Although it can be noticed to have adverse effects, it enhances the mortality of lung cancer than the chest radiography method. LCT method is used at early stages or before any detection of the disease. The NLST puts it clear that, “screening with low-dose helical computed tomography (CT) of the chest in patients at high risk for lung cancer was associated with a 20% reduction in lung-cancer mortality” (Black et al., 2014). Lung cancer is the most prevalent type of the cancer cell globally. In the US alone, lung cancer is the second leading cause of deaths (Kitts, 2015). This also consequently places it on the top spot for the leading causative agents of cancer-related deaths in the USA (Black et al., 2014). Therefore, it has compelled numerous medical groups and societies in the country into recommending low-dose CT for screening on patients whose risk of lung cancer is quite high (Black et al., 2014).

Furthermore, the PSTF in the US (Preventive Services Task Force), equivalently issued “a grade B recommendation for low-dose CT screening, which means that private insurers must cover the cost of screening” (Black et al. 2014). However, the establishment of the low-dose CT (LCT) brought renewed hope with respect to the fight against cancer. Despite the fact that the screening technique is significantly effective, its cost-benefits have been a top subject of consideration for multifarious experts and policy makers. A number of the studies regarded the low-dose CT’s cost benefit analysis as being generally favourable (Black et al., 2014). However, later studies concluded its cost benefit analysis as highly unfavourable.

Problem Statement

Albeit the low-dose CT guarantees an improved support in the fight against lung cancer in the future. But, matters to do with its cost effectiveness on the participant and healthcare payers are uncertain. This situation is made more daunting due to the fact that no solid research has been conducted previously to ascertain the cost effectiveness of the latter. Additionally, the literature that currently exists with respect to the cost benefits of the low-dose CT are extremely contradictory and have exemplified major vulnerabilities to criticism among the public. Only a small portion of the available literature bears some significance as much as the cost benefit analysis of the low-dose CT is concerned. Explicitly, the insufficiency in existing literature has brought about more scrutiny on the low-cost CT. This comes at a time when lung cancer is not only a great threat in the United States, but also in the whole globe. Lung cancer has continuously posed detrimental effects to the human population with a continuous increase in the number of individuals being lost to the disease. For instance, the aforementioned number of individuals lost in 2012 to cancer; 1.2 million, gives experts and scientists more than enough reason to raise the flag with regards to this deadly infection.

It is quite interesting that within a very short period of time, cancer has surpassed other infections, which would impose detrimental effects towards the human population such as malaria and the HIV virus which culminates into AIDS. Therefore, nations such as the United States have frequently called for a renewed fight against the deadly lung cancer which continues to rip it off its citizens. With inventions such as the low-dose CT, new hope has been bestowed upon the whole world in the fight against lung cancer. To countenance this fight, further research regarding the cost benefit analysis of the low-dose CT is essential. Hopefully, this research aims at adding unto existing research concerned with the cost benefit analysis of the low-dose CT.

Hypothesis:

If we increase the participation in low-dose computed tomography for high-risk individuals, then the participant medical and payer financial risk will decrease.

Hypothesis testing:

Ho:

  1. Increasing the participation in low-dose computed tomography for high risk individuals will have no effect on cumulative quality-adjusted life years gained

  2. Increase the testing, we do not show a difference in the quality-adjusted life years

H1

  1. Increasing the participation in low-dose computed tomography for high risk individuals will have difference in the quality-adjusted life years

  2. Increasing the participation will reduce the financial burden of health insurance provider

  3. Increasing the participation will reduce the financial burden of individuals

CHAPTER 2: LITERATURE REVIEW

Literature Search Strategy

In my analysis, I review several literatures affiliated to my subject of research. For instance, I concisely review the clinical trials and studies conducted by the National Health Institute and the National Cancer Institute between the years 2006-2012. In 2011, the New England Journal of medicine, under the funding of the National Cancer Institute, published a report which documented that the low-dose CT suppresses cancer mortality by 20%. This is as contrasted to the chest radiography technique used in screening for any high lung cancer risks among tobacco users and thus, evidences the effectiveness of the low-dose CT. The England Journal of Medicine specified clearly that their objective was to rather contrast both the low-dose CT screening and the chest radiography so as to consequently conclude whether the former or the latter had the capability to suppress mortality among participants (tobacco smokers in this case) who were at extremely dudgeon risks of contracting lung cancer. Therefore, countenanced the details that were revealed in the National Lung Screening Trials.

The National Lung Screening Trials’ (NLST) main objective was to compare and contrast the most effective screening method between the chest radiography or the low-dose CT. Their studies were similar to the report published by the England Journal of Medicine. The Primary outcome measure in the trails was to follow lung cancer deaths in the time frame; median follow up was for 6.5 years. The lung cancer death was confirmed by Endpoint verification or by death certificate. However, the secondary outcomes were numerous. Vital among these, was the causes of death in all participants who had been randomly selected. Just like before, the median follow up was 6.5 years. In the secondary outcomes, death was contrasted between patients who had undertaken the chest radiography and those who undertook the low-dose CT. Previous diagnosis for lung cancer had also been ascertained by the medical records.

Lung Cancer and Usage of Low-Dose Computerized Tomography (LDCT)

Experts suggest that the probability of acquiring the deadly lung cancer infection among smokers today, is quite dudgeon than what the stakes had been 50 years ago (Kitts, 2015). In addition, experts outline that the damages put forth by lung cancer normally aggravate with age as well as the frequent exposure to contributing factors such as tobacco smoking. Reports suggest that quite a number of the diagnoses made with regards to lung cancer are usually made when a patient’s conditions delve into its late stages (Kitts, 2015; Aberle, Abtin, and Brown, 2013). This is clearly due to the fact that the disease portrays quite a low number of symptoms during its early stages. Worse still, the Low-Dose Computerized Tomography (LDCT), which is majorly responsible for the screening of the cancer cells was only invented and consequently, put forward to the public in the year 2015 (Kitts, 2015). In the USA alone, in both men, women, and children, lung cancer has been identified as the second leading causative agent of cancer-related deaths (Humphrey et al., 2013). Moreover, scientists approximate that a total of close to 160,000 individuals pass away as a result of the deadly cancer cells.

It is also vital to note that globally, lung cancer stands as the widely-known type of cancer. In the year 2012 alone, it is recorded to have resulted to the eventful loss of lives of an estimated 1.6 million individuals (Kitts, 2015). However, on a more positive point of view, reports of the acquisition of lung cancer and the subsequent deaths that come with it have been drastically decreasing over a period of the last 25 years (Black, Gareen, Soneji, Sicks, Keeler, Aberle, Naeim, Church, Silvestri, Gorelick, and Gatsonis, 2014). Screening may be defined as the utility of tests or alternatively, exams, to detect diseases in people whose body organs or systems have not yet portrayed any symptoms related to the infection. Screening has majorly been used in detecting cancer cells among cancer patients and therefore, is crucial among them. Lung cancer is generally common among adults of ranging between the ages of 55 and beyond and its incidences are reported to go higher by age. Among all forms of cancer, the five-year survival rate is ranked among the poorest. It clocks in at a low 17%. However, when detected at its early stages though screening, lung cancer is suggested to have the highest five-year survival rate which clocks in at around 52%. Unfortunately, studies and experts have suggested that only a minute 15% of lung cancer cases are successfully detected while at their very early stages (Goulart et al. 2012; Villanti et al. 2012).

The antecedent is therefore an explicit indication on why the search for a reliable screening method with regards to lung cancer has been a top priority for most scientists and a majority of governments for many years. This explains why the discovery of the low-dose CT brought so much joy with it. The low-dose CT has been recommended by the United States Preventive Services Task Force for annual screening on lung cancer patients, adults to be precise, aged between the ages of 55 and 80 and additionally, who have a 30-pack year smoking history. Moreover, the participants of the low-dose CT should be current smokers or should have quit smoking at most 15 years prior to testing. The low-dose CT is also said to have the capability to avert patients from culminating into advanced lung cancer diagnosis. The low-dose CT has a level “B” rating from the United States Preventive Service Task Force. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial and it recommends the service. The National Lung Screening Trial (NLST) proved that screening via the use of the recently-presented Low-Dose Computerized Tomography (LCT) was far much effective in enhancing lung cancer mortality than the chest radiography (Black et al. 2014). This was done through the randomizing of 53,454 smokers, either who had quit smoking previously, or who were still smokers. Despite the fact that it yielded far more better results than the chest radiography, the low-dose CT is also said to have its own share of disadvantages such as; patients are exposed to deadly radiation rays, it may prospectively lead to over diagnosis, wrong positive rates that are additionally quite high (Aberle, Abtin, Brown, 2013).

Medical Perspective of Low-Dose Computerized Tomography (LDCT)

A previous combination of two screening techniques; the chest radiography (CXR) together with sputum cytology, had failed to yield the anticipated results with respect to exemplifying the benefits of screening in relation to prospective lung cancer mortality rates (Aberle et al. 2013). Lung cancer’s largest risk factor has been identified as tobacco smoking which has a tremendous 85% affiliation to the reported cases in the United States alone (Humphrey et al. 2013). Moreover, lung cancer has also been associated to family genetics. However, during the recent years, researchers have intensified their research on the low-dose CT screening technique which had portrayed significant mortality benefits (Aberle et al. 2013). In quite a number of studies which based on distinct factors such as “cohort characteristics, numbers of screening rounds, interpretation criteria for a positive screen, and whether LDCT was performed alone or in conjunction with CXR” (Aberle et al. 2013, p.1002). As a result of this, scientists concluded that the low-dose CT screening technique had a dudgeon capability raising the detection of lung cancer through its ability to point out the nodules in the lungs in addition to the cancers that yield up to lung cancer (Aberle et al. 2013). This is in contrast to the other screening techniques like the chest radiography and sputum cytology.

However, as much as it comes along with its own benefits, medical experts have also emphasized on the need to balance between the screening benefits of the low-dose CT together with the maximum risks brought about by exposure to harmful radiation rays through the usage of the low-dose CT method (Humphrey et al. 2013). In addition, due to the fact that some cases and instances of falsely identified positive results have previously been reported, experts have advised regarding an increase in more research that would be beneficial in improving the effectiveness of the low-dose CT. Additionally, it has also been maintained that the best means so far to curb excessive lung cancer mortality is through smoking cessation (Humphrey et al. 2013).

Overall Healthcare Burden

According to Humphrey et al. (2013), a favourable method of screening must always be appealing in all terms. This is due to the fact that early screening of lung cancer may be beneficial in the treatment of the disease while in its preamble stages. This should therefore translate to the fact that a good screening method “should be sensitive, specific, acceptable to patients and providers, and relatively cost-effective” (Humphrey et al. 2015, p.4). Despite the fact that the low-dose CT seriously promises and convinces to be a reliable and effective screening method, it is still quite unclear on whether the said screening technique would have some cost benefits towards its participants or users. Villanti, Jiang, Abrams, and Pyenson (2013), demonstrate the cost benefit analysis for potential lung cancer patients who use the low-dose CT screening method in contrast to the costs coughed out by other cancer patients in per terms of per member per month (PMPM). The graph below illustrates their 2012 findings;

In the year 2012, the low payer cost in terms of per member per month for lung cancer was the lowest among the four, coming in at US $0.76. Breast cancer had the highest with $2.50 while cervical cancer and colorectal cancer both had $1.10 and $0.95 respectively (Villanti et al. 2013). Additionally, after repeated screenings of the low-dose CT technique, it was concluded that it resulted in low cost savings for its participants annually, as compared to the other forms of cancer screening such as for the breast, colorectal, and the cervical cancer screening (Villanti et al. 2013). Past studies have often reported cost-effectiveness per life saved through the use of the low-dose CT. For instance, “the first study reported the incremental cost-effectiveness of a one-time screening at $15,274 (1999 USD; $25,064 in 2012 USD) per life year saved in a high prevalence scenario and up to $58,183 (1999 USD; $95,478 in 2012 USD) per life year saved assuming low lung cancer prevalence when accounting for a lead-time bias of one year” (Villanti et al. 2013, p.3). It is also reported that the second study suggested that the low-dose CT is highly cost-effective. This was after repeated screenings had been conducted (Villanti et al. 2013). It is also vital to note that these suggested mainly based on adult populations that were at extremely high risks of contracting cancer. The adult participants were all aged between the ages of 50-64. Experts and researchers therefore concluded that the low-dose CT screening method is of significant cost-effectiveness when utilized in adult populations (Villanti et al. 2013).

However, Mahadevia et al. (2003), as cited in Villanti et al (2013), argues that the low-dose CT is not suitable for use within populations with massive usage of tobacco since it would no longer be cost-effective. Additionally, a distinct study conducted in 2005 in Australia and funded by the Australian, also came up with the same results, giving an assumption that unless the low-dose CT achieved a 20% reduction in the mortality rates associated with lung cancer, it was not likely to be cost-effective. The study’s assumption was that the society would barely be willing to cough out $50,000 on the basis of a life saved per annum unless the technique would highly achieve and consequently, surpass the aforementioned rate (Villanti et al. 2013). McMahon’s et al. n.d. study also pointed out to the fact that the low-dose CT would be quite lucrative for a majority of people. In his study, he estimated that each one would be required to pay approximately a sum of between $154,000 and $207,000 per quality of a life saved (as cited in Villanti et al. 2013). In the USA alone, it is estimated cancer menace alone costs the US government an approximate $147.5 billion in the year 2015. $13.4 billion of this went to lung cancer alone (National Cancer Institute, 2017). It is also estimated that lost productivity resulting from early deaths brought about by cancer cost the US a total sum of $134.8 billion in the year 2015. Among this, lung cancer alone was responsible for $36.1 billion (National Cancer Institute). The National Lung Cancer Trials also estimated that for smokers between the ages of 50-74, the low-dose CT ranged from a minimum of $126,000 to $169,000/ quality – adjusted – life – year (QALY) on the basis of a minimum smoking pack of twenty years. Alternatively, it suggested that for a minimum of a forty years pack, the cost fall between $110,000 and $166,000/ QALY (Black et al. 2014; National Cancer Institute, 2017; Humphrey et al. 2015; Villanti et al. 2012).

Social Perspective for Effective Screening

Over the years, researchers and cancer experts had tried hard in coming up with an effective screening solution that would reduce the high rates of cancer mortality which was apparently, similar to a menace. The rate at which cases of cancer were being reported had significantly rose globally and hence, creating panic among people, scientists, and researchers. This led to governments imposing more stringent measures against the excessive smoking of tobacco cigarettes. As a matter of fact, tobacco production was regulated globally in a bid to encourage smoking cessation. However, the numerous cases of lung cancer being reported continued to rise steadily. When the low-dose CT was first tested and projected appealing results, it brought significant hope with it. Previous screening techniques such as the chest radiography and sputum cytology had largely failed in detecting cancer cells while at its early stages.

Lung cancer specialists and the experts behind the low-dose CT screening method have continuously praised it with a vast array of benefits. Definitely, apart from the experts, the low-dose CT is definitely an effective screening technique. Its ability to detect the small lung cancer nodules while at its treatable stages is more than impressive and gives it an upper hand. Additionally, the low-dose CT is extremely fast, non-invasive, and attains approximately 90 percent less ionizing radiation, highly surpassing a traditional CT (Black et al. 2014; Humphrey et al. 2015; Villanti et al. 2012). However, due to lack of adequate research and literature awareness, a majority of the public barely know anything with regards to the low-dose CT and its essentiality to the population (Black et al. 2014; National Cancer Institute, 2017). However, a 2014 study from Mexico, which utilized questionnaires in interviewing its participants, concluded by suggesting that quite a number of people are fully aware of the low-dose CT. In addition, the study further reported that quite a number of the people were paranoid regarding the low-dose CT due to its cost and the maximum exposure to radiation.

The low-dose CT has also turned out to be difficult being incorporated in a socio-demographically diverse population (Villanti et al. 2012). However, Aberle et al. (2013), argues that the use of the low-dose CT does not culminate into other detrimental effects that may result in death during its testing. However, he further acknowledges that “The benefits of screening must be reconciled with its potential harms, which are primarily related to radiation-induced carcinogenesis, high false-positive rates, and the potential for over diagnosis” (Aberle et al. 2013, p.1004). To solidify the fears of the exposure to harmful radiation rays, it should also be noted importantly that the low-dose CT subjects its participants to a continuous exposure to harmful rays since its process of screening is continuous too and occurs periodically over a long period of time. This has even fuelled more and more paranoia among the intended audience (potential lung cancer patients).

The fact that some reports have suggested that in order to save one life, an estimated 465 to 601 individuals should be screened has also pointed out the weaknesses portrayed by the low-dose CT method (Aberle et al. 2013). The low-dose CT has also previously fallen under intense scrutiny and criticism due to the few number of cases reported regarding the extremely high positivity rates. Unfortunately, the extremely dudgeon number of positive outcomes have often been false. The credibility of the low-dose CT therefore, came in shambles and its experts had a hard time clarifying the unfortunate occurrences. This led to a majority of participants questioning its previous results and whether it was worth the very lucrative costs it had required for screening. In addition, the fact that the National Lung Cancer Trials had older individuals and individuals with a long smoking history as its targeted, it is equally and arguably a daunting task to determine whether the low-dose CT’s results were accurate. This is after giving consideration the fact that other underlying factors such as “underlying chronic obstructive lung disease, occupational exposure to asbestos or other carcinogen, history of lung cancer in a first-degree relative, and prior history of lung (or other cancer) (Aberle et al. 2013, p.1004)” were not considered.

Lung Cancer Treatment Cost

With each and every year passing by, the costs of maintaining, treating, in addition to productivity costs related to cancer have been steadily rising (Aberle et al. 2013; Black et al. 2014; Humphrey et al. 2015; Villanti et al. 2012). In general, the disease grosses nearly 10% to 50% of its total treatment costs from the patient alone. To make matters worse, during the process of treating lung cancer and other forms of cancers, other numerous forms of treatment interventions may be necessary. Some of these treatment interventions include; chemotherapy which is estimated to cost nearly $10,000-$200,000, surgery, which costs not less than $15,000, and radiation therapy which is estimated to cost nearly $10,000-$50,000 (Black et al. 2014). Consequently, any cancer patient who has been subjected to treatment through the above processes, will require a continuous drug therapy process so as to sustain and facilitate full recovery. The drug therapy is estimated to cost nearly $4000 in a single month.

Several studies conducted previously, have had their estimates on the total costs for a regular cancer patient in being subjected through a portion of the processes i.e. from the diagnosis of the cancer cells, towards two years thereafter as being too lucrative for an ordinary citizen in any given nation. To be precise, the estimates for the total costs for a cancer patient from the point of diagnosis to two years later stands at an approximated $46,000. In order to countenance this, the break up costs of the whole treatment processes have been described as to consist both of the hospitalization (inpatient) costs as well as the outpatient costs. This is in addition to an initial monthly treatment phase cost which is estimated at $11,500 for a single patient. It is therefore estimated that in the coming years, the already-lucrative costs of cancer may fuel and surpass, interestingly, the overall expenditure dished out to other medical sectors (National Cancer Institute, 2017). The extremely high and unaffordable cancer costs’ significant rise has been attributed to the fact that the more new and advanced systems of standard care have been adopted in a bid to curb the disease (National Cancer Institute, 2017). The low-dose CT is one such modern and advanced systems.

For the low-dose CT, it is estimated that for one screening visit, a patient is required to pay at least $101. This also applies to each surgical and workout visit (Black et al. 2014). On a study conducted by Black et al. 2014, he also suggests that the total cost a lung cancer patient had to pay for time and travel on each radiation therapy was nearly $175 for each visit. For a single visit with affiliation to chemotherapy, a patient had to cough out at least $385 (Black et al. 2014). Screening through the use of chest radiography was concluded to be more expensive but rather, bore no substantial results. On the other hand, “As compared with no screening, screening with low-dose CT cost an additional $1,631 (95% confidence interval [CI], 1,557 to 1,709) per person and provided an additional 0.0316 life-years per person (95% CI, 0.0154 to 0.0478) and 0.0201 QALYs per person (95% CI, 0.0088 to 0.0314); the corresponding ICERs were $52,000 per life-year gained (95% CI, 34,000 to 106,000) and $81,000 per QALY gained

(95% CI, 52,000 to 186,000)” (Black et al. 2014, p.1798). Goulart, Bensink, Mummy, and Ramsey (2012) suggest that the cost of cancer treatment without screening would cost an estimated $2.8 billion annually. This is inclusive of the over-diagnosis costs. Additionally, their study suggests that in the United States, the low-dose CT screening technique would cost the US system of healthcare approximately $1.3 billion to $2.0 billion per annum (Goulart et al. 2012).

Healthcare Payer Costs

A majority of the healthcare providers share the burden with regards to lung cancer-related costs. It is estimated that the share ranges between an 80:20 aspect ratio. Most of the healthcare providers have often outlined the average cost of initial diagnosis as $60,701 for participants falling at the age of 65 (Black et al. 2014; Goulart et al. 2012). Additionally, it has been approximated that a follow-up cost of $7,591 is required from patients annually and on a continuous period of time. The average cost of a new lung cancer drug has also been estimated to cost at least $100,000 annually. It is also estimated that some of the drugs utilized in the lung cancer therapies go for extremely lucrative costs of up to $30,000 (Aberle et al. 2013; Black et al. 2014; Goulart et al. 2012; Humphrey et al. 2015; Villanti et al. 2012). In 2012, it is estimated that the mean hospital costs affiliated to lung cancer was approximately $21,200 (Aberle et al. 2013; Goulart et al. 2012; Humphrey et al. 2015; National Cancer Institute, 2017; Villanti et al. 2012). This is suggested to be 2.5 times higher than medical stays in addition to being five times more than the costs of maternal and neonatal stays.

For a scan copay of the percentages 20, 10, and, 0 consecutively, an average cancer patient is required to spend $151, $99, and $46 annually (Goulart et al. 2012). This is following an assumption that “a fixed copay of 20% for all tests, procedures, and treatments that follow a positive screening test” (Goulart et al. 2012, p.271).

CHAPTER 3: METHODOLOGY

Research Design Process

  • Research Design

Descriptive: I will be using quantifiable data from available source and use statistical explanation.

Correlation/Regression Analysis: I will determine the relationship in-between participant LDCT and health benefits and financial gains.

  • Source of data

Participants various in LDCT studies

Probability Sampling

Non-probability sampling

  • Data gathering procedure

Data will be extracted from the Studies conducted by various healthcare agencies including CDC

Data will be extracted Studies conducted by various for non- profit organization including national cancer institute

  • Data analysis

Data will be presented and analysed through various tables and graphs/charts. The multiple R, t value, P-value and the value of R-square are analysed. This data analysis will either reject or accept the null hypothesis.

  • Statistical treatment

Hypothesis Testing

  • Financial analysis

Quantitative forecasting

Data Interpretation

After the critical analysis of the results brought about by the data, I will either settle on a decision on whether to reject or accept the report by the null hypothesis. The data is projected below.

Data Generation

Eligible smoker

LDCT screen done

Deaths every year

Preventable death

LDCT criteria

Rate of screening

Insurance

6 million

262,700

155,000

12,000

55-80 years’ age

3.3 % in 2010

50% met criteria were uninsured or Medicaid recipient

30 or more packs-year

3.9% in 2015

Currently smoker or quit in past 15 years

NLST screening results

reductions in lung cancer mortality

quality-adjusted life years (QALYs) in USA

Direct cost of smoking per year (average U.S price)

Average additional Premium rate for smoker

Average additional cost of insurance for smoker

Average Patient-liability costs

20 % decrease in relative death

0.4 %

$50,000

$3,500

40.5%

39 states= 50% max.

79%

21.%

Average Annual health care cost younger than 65

Average annual health care-

no lung cancer

$21,222

$3,450

Observed Values

OBSERVED VALUES

Participation Scenario

Overall costs over 10 years ($ Millions)

Overall Costs over 20 years ($ Millions)

No screening

5700.6

10926.7

age 55 – 74

6838

13097

20 pack-years

7155.9

13918

40 pack-years

6512.4

12413.3

age 55 – 69

6572.4

12482.6

age 55 – 79

7012

13562.3

age 55 – 84

7100.9

13830.8

age 50 – 69

6764.3

12800.6

20 % participation

6121.9

11701.5

40 % participation

6477.8

12399.9

70 % participation

7017.3

13452.2

80 % participation

7194.3

13798.2

Findings

Figure. Participation Percentage in screening according to the value in both 10 years and 20 years

Fig. Screening process including age packets and participation

The Summary Output from Regression (Null Hypothesis Testing)

SUMMARY OUTPUT

Regression Statistics

Multiple R

0.990991647

R Square

0.982064444

Adjusted R Square

0.980071605

Standard Error

48.19620129

Observations

11

ANOVA

df

SS

MS

F

Significance F

Regression

1

1144704.192

1144704.192

492.7965449

3.61167E-09

Residual

9

20905.86437

2322.873819

Total

10

1165610.056

Coefficients

Standard Error

t Stat

P-value

Lower 95%

Upper 95%

Intercept

780.8718494

271.3988505

2.877211337

0.01826081

166.9249958

1394.818703

10926.7

0.461308172

0.020780564

22.19902126

3.61167E-09

0.414299271

0.508317073

Table: This shows the regression analysis of the overall costs between the 10 years’ costs and the 20 years’ costs.

Interpretation of the Regression Analysis

  1. The value of multiple R is 0.990991647, that is approximately 99.10%. This shows that the model has 99.10% of the variance in the dependent variable, which is the overall costs of the two phases (10 years and 20 years). These analysis rejects the null hypotheses.

  2. The Value of R-square is 0.982064444, that is, 98.21%. In this analysis, it is clear that there is a great closeness of the data analyzed to the fitted regression line. This is the coefficient determinant. Therefore, the variability of the response data is around its mean, simply meaning the model fits the data, which then shows the rejection of the null hypotheses.

  3. The value of t stat is 2.877211337 and the P-value is 0.01826081. The t value is greater than +2, therefore, indication of high reliability of the predictive power of the coefficient that exist on the relationship of the costs on the screening between 10 years and 20 years. Thus, from the tests, these values show a greater of the evidence against the null hypotheses.

Final Financial Test

The chart above represents an incremental costs test conducted by the New England Journal of Medicine. Its findings are conclusively discussed below. From its analysis on the cost benefits of the low-dose computerized tomography, the New England Journal of Medicine suggests that the incremental costs after initiation of the low-dose CT stay stable as compared to initial costs without screening or via the use of the chest radiography (Black et al. 2014). The value is estimated to range between the sums of $1,453 to 1,905 (Black et al. 2014). However, the quality – adjusted – life – year (QALY’s) range is reported to be much wider with an estimated 0.0027 to 0.0515. As contrasted to the QALY value of the chest radiography, the QALY values of the low-dose CT are recorded to be up to a nearly humongous 20 times higher than the value recorded for a low-dose CT quality – adjusted – life – year value (Black et al. 2014). Additionally, the cost spent by women per QALY was also recorded to be extremely lower than that for men. In essence, it was a $46,000 contrasted to a tremendous $147,000 respectively. Similarly, the cost per QALY was much lower for individuals who were currently smoking. However, for former smokers, the cost per QALY was much higher (Black et al. 2014). The exact figures were recorded to be a mere $43,000 against a humongous $615,000 consecutively (Black et al. 2014).

For patients with an extremely high chance of contracting lung cancer, the costs through the low-dose CT screening were also significant. Without an inclusivity of future health costs, the figure clocks in at $62,000 which is a bit lower, 0.94, as compared to the costs for screening with the chest radiography techniques or alternatively, no screening at all (Black et al. 2014). However, with the inclusion of future costs related to the patient’s healthcare, the costs skyrocket to $100,000 and in some cases, exceed it. Some of the situations which act as incentives to the increase in healthcare costs witnessed include: surgery, screening examination, or additional follow-ups (Black et al. 2014). The screening costs for lung cancer were also suggested to increase than the costs approximated following the National Lung Cancer Trials (NLCT). The cost-effectiveness of the low-dose CT is also suggested, through analysis, to be higher and more leaning towards women than in men. It is also suggested that the cost-effectiveness of the low-dose CT is more prevalent within groups with a higher risk of contracting lung cancer than in those with a lower risk of contracting cancer (Black et al. 2014). In general, screening with the use of the low-dose computerized tomography is highly cost-effective among women groups than in the other three groups. By virtue of this, women are rather more advantageous. Hence, these countenances previous reports which had suggested that the low-dose CT is much more effective in women and thus, making it cost-effective among them too (Goulart et al. 2012).

CHAPTER 4: FINANCIAL BUSINESS MODEL

4.1. Financial Business Model Developed

Characteristics

No. of Participants

Incremental Costs

Incremental QALYS

Cost per QALY

Male

31,446

1,683

0.0115

147,000

Female

21,856

1,557

0.034

46,000

Entry Ages

55–59 yr

22,773

1,541

0.0101

152,000

60–64 yr

16,333

1,520

0.032

48,000

65–69 yr

9,504

1,900

0.0351

54,000

70–74 yr

4,685

1,905

0.0163

117,000

Smoking Status

Former

27,643

1,661

0.0027

615,000

Current

25,659

1,601

0.0369

43,000

Risk of lung cancer

First quintile

10,660

1,453

0.0086

169,000

Second quintile

10,661

1,454

0.0118

123,000

Third quintile

10,660

1,651

0.0061

269,000

Fourth quintile

10,661

1,672

0.0515

32,000

Fifth quintile

10,660

1,851

0.0354

52,000

4.2. Financial Recommendations

My financial business model replicates that of Black et al.’s (2014) published in the New England Journal of Medicine. Previous studies have linked several challenges regarding the low-dose computerized tomography. Dominant among these challenges is the cost-effectiveness of the latter. Several questions still linger on whether the LDCT screening method should be offered widely among patients with a high risk of contracting cancer, or better still, among participants with a low risk of getting cancer. Despite the fact that offering the low-dose CT screening to individuals with a high risk of getting cancer is expensive, no study has advised against. However, in order to curb the challenge of high costs involved, I would recommend by countenancing previous studies that the LDCT should not be offered to individuals with low risks of cancer mortality for optimal cost-effectiveness issues. In addition, “for optimal cost-effectiveness, individuals with a sufficiently high risk of developing lung cancer need to be identified so that the benefit-to-harm ratio of the screening can be maximized” (Cui, Li, Han, and Liu, 2015, vol). In addition, I recommend an increased number of participants in order to lower the costs incurred through the use of the low-dose CT.

CHAPTER 5: CONCLUSION

Despite the fact that the journal was majorly a perspective from England’s eye view of the low-dose CT, it also incorporated previously published evaluations and dynamics from both the United States and Japan. However, the study by the Medicine Journal of England was not able to come up with a coherent conclusion on the cost-benefits of the low-dose CT. This was due to the fact that both the literature and evidence with respect to the low-dose computerized tomography was feeble, weak, and rather not substantial enough at the time. “The main limitations found in the reviewed studies were the lack of evidence supporting a mortality benefit from LDCT screening, lack of consideration for the costs of procedures caused by false-positive results, no consideration for screening adherence, and no assessments of the budget impact of LDCT screening on national health care expenditures”. Up to date, the major positive financial aspects or rather, the cost benefits of the low-dose CT have not been concisely outlined by a majority of studies. A huge cloud of uncertainty still clumber over the cost effectiveness of the technique. Factors such as the aforementioned, in addition to the hazardous effects associated with the use of the low-dose CT due to the harmful radiation rays have been a major impediment in the renewed calls of encouraging potential lung cancer patients to take part in the screening method. It is therefore crucial that future studies prioritise the identity of the low-dose CT’s cost benefits so as to encourage more people to participate in the said screening method. Concerning the analysis, it was shown that the null hypothesis was rejected. The R-value, t-value and multiple R shows that, “If we increase the participation in low-dose computed tomography for high-risk individuals, then the participant medical and payer financial risk will decrease.” Moreover, offering incentives to people will increase the participation in the screening process.

References

Aberle, D. R., Abtin, F., & Brown, K. (2013). Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. Journal of Clinical Oncology31(8), 1002-1008.

Black, W. C., Gareen, I. F., Soneji, S. S., Sicks, J. D., Keeler, E. B., Aberle, D. R., … & Gatsonis, C. (2014). Cost-effectiveness of CT screening in the National Lung Screening Trial. New England Journal of Medicine371(19), 1793-1802.

Goulart, B. H., Bensink, M. E., Mummy, D. G., & Ramsey, S. D. (2012). Lung cancer screening with low-dose computed tomography: costs, national expenditures, and cost-effectiveness. Journal of the National Comprehensive Cancer Network10(2), 267-275.

Humphrey, L. L., Deffebach, M., Pappas, M., Baumann, C., Artis, K., Mitchell, J. P., … & Slatore, C. G. (2013). Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation. Annals of internal medicine159(6), 411-420.

National Cancer Institute. (2017). Financial Burden of Cancer Care. Retrieved from https://www.progressreport.cancer.gov/after/economic_burden

Villanti, A. C., Jiang, Y., Abrams, D. B., & Pyenson, B. S. (2013). A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions. PloS one8(8), e71379.