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Cost-effectiveness of lung MRI in lung cancer screening

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Recent studies with lung MRI (MRI) have shown high sensitivity (Sn) and specificity (Sp) for lung nodule detection and characterization relative to low-dose CT (LDCT). Using this background data, we sought to compare the potential screening performance of MRI vs. LDCT using a Markov model of lung cancer screening.

Methods

We created a Markov cohort model of lung cancer screening which incorporated lung cancer incidence, progression, and mortality based on gender, age, and smoking burden. Sensitivity (Sn) and Sp for LDCT were taken from the MISCAN Lung Microsimulation and Sn/Sp for MRI was estimated from a published substudy of the German Lung Cancer Screening and Intervention Trial. Screening, work-up, and treatment costs were estimated from published data. Screening with MRI and LDCT was simulated for a cohort of male and female smokers (2 packs per day; 36 pack/years of smoking history) starting at age 60. We calculated the screening performance and cost-effectiveness of MRI screening and performed a sensitivity analysis on MRI Sn/Sp and cost.

Results

There was no difference in life expectancy between MRI and LDCT screening (males 13.28 vs. 13.29 life-years; females 14.22 vs. 14.22 life-years). MRI had a favorable cost-effectiveness ratio of $258,169 in men and $403,888 in women driven by fewer false-positive screens. On sensitivity analysis, MRI remained cost effective at screening costs < $396 dollars and Sp > 81%.

Conclusions

In this Markov model of lung cancer screening, MRI has a near-equivalent life expectancy benefit and has superior cost-effectiveness relative to LDCT.

Key Points

• In this Markov model of lung cancer screening, there is no difference in mortality between yearly screening with MRI and low-dose CT.

• Compared to low-dose CT, screening with MRI led to a reduction in false-positive studies from 26 to 2.8% in men and 26 to 2.6% in women.

• Due to similar life-expectancy and reduced false-positive rate, we found a favorable cost-effectiveness ratio of $258,169 in men and $403,888 in women of MRI relative to low-dose CT.

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Abbreviations

LDCT:

Low-dose computed tomography for lung cancer screening

LUSI :

German Lung Cancer Screening Trial

MISCAN:

Microsimulation screening analysis lung simulation

MRI:

Lung magnetic resonance imaging for lung cancer screening

NLST:

National Lung Cancer Screening Trial

PLCO:

Prostate, lung, colon, and ovarian cancer screening trial

SEER:

Surveillance, epidemiology, and end result

Sn:

Sensitivity

Sp:

Specificity

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Acknowledgments

The authors wish to recognize Joey Kong, PhD, and Pari Pandharipande, M.D., M.P.H., for their contributions to this manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Bradley D. Allen & James C. Carr

  2. Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI, USA

    Mark L. Schiebler

  3. Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland

    Gregor Sommer

  4. Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany

    Hans-Ulrich Kauczor & Juergen Biederer

  5. Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany

    Hans-Ulrich Kauczor & Juergen Biederer

  6. Faculty of Medicine, University of Latvia, Riga, Latvia

    Juergen Biederer

  7. Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany

    Juergen Biederer

  8. Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University , Chicago, IL, USA

    Timothy J. Kruser

  9. Department of Industrial Engineering and Management Sciences, Northwestern University, Chicago, IL, USA

    Gordon Hazen

Authors
  1. Bradley D. Allen
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  2. Mark L. Schiebler
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  3. Gregor Sommer
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  4. Hans-Ulrich Kauczor
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  7. James C. Carr
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Correspondence to Bradley D. Allen.

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Guarantor

The scientific guarantor of this publication is Bradley Allen, MD, MS.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (GBH) has significant statistical expertise.

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Written informed consent was not required for this study because analysis was based on previously published results available in the literature.

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Institutional Review Board approval was not required because of the statistical/mathematical nature of this work.

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Allen, B.D., Schiebler, M.L., Sommer, G. et al. Cost-effectiveness of lung MRI in lung cancer screening. Eur Radiol 30, 1738–1746 (2020). https://doi.org/10.1007/s00330-019-06453-9

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  • DOI: https://doi.org/10.1007/s00330-019-06453-9

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