Table 1 Input parameters of Markov model for lung cancer screening
Parameters | Base case (range) | Distribution | Reference |
|---|---|---|---|
Lung cancer incidence | Changing with age and smoking intensity | - | LDCT screening cohort |
Transition probabilities | |||
Lung cancer stage I to stage II | 0.3682 (± 50%) | Beta (9.33, 16.01) | [28] |
Lung cancer stage I to stage III | 0.0328 (± 50%) | Beta (14.83, 437.29) | |
Lung cancer stage I to stage IV | 0.0745 (± 50%) | Beta (14.15, 175.75) | |
Lung cancer stage II to stage III | 0.2260 (± 50%) | Beta (11.67, 39.96) | |
Lung cancer stage II to stage IV | 0.1510 (± 50%) | Beta (12.89, 72.50) | |
Lung cancer stage III to stage IV | 0.1455 (± 50%) | Beta (12.98, 76.26) | |
Mortality | |||
Mortality of non-lung cancer death | See Table S2 | ||
Lung cancer stage I to LC death | 0.1739 (± 50%) | Beta (12.52, 59.48) | |
Lung cancer stage II to LC death | 0.2942 (± 50%) | Beta (10.55, 25.31) | |
Lung cancer stage III to LC death | 0.4626 (± 50%) | Beta (7.79, 9.06) | |
Lung cancer stage IV to LC death | 0.5880 (± 50%) | Beta (5.74, 4.02) | |
Aftercare I to death | 0.089 (± 50%) | Beta (13.91, 142.23) | [31] |
Aftercare II to death | 0.153 (± 50%) | Beta (12.86, 71.32) | |
Aftercare III to death | 0.288 (± 50%) | Beta (10.65, 26.34) | |
Aftercare IV to death | 0.353 (± 50%) | Beta (9.59, 17.60) | |
Performance of LDCT | |||
Sensitivity of LDCT | 0.937 (0.890–1.000) | Beta (649, 44) | [32] |
Specificity of LDCT | 0.765 (0.700–0.930) | Beta (56,936, 17,497) | |
Overdiagnosis rate when screening | 0.031 (± 50%) | Beta (14.86, 464.46) | |
Excess relative risk of LC per screening | 0.001 (0.0003–0.0019) | Beta (6, 5995) | |
Adherence to LDCT screening | 100% (50–100%) | Triangle (0.5, 1, 1) | Assumption |
Diagnose rate through standard clinical care | |||
Lung cancer stage I | 2.46% (± 50%) | Beta (14.96, 593.32) | [27] |
Lung cancer stage II | 2.7% (± 50%) | Beta (14.91, 537.48) | |
Lung cancer stage III | 51.8% (± 50%) | Beta (6.89, 6.41) | |
Lung cancer stage IV | 65.8% (± 50%) | Beta (4.60, 2.39) | |
Cost (CNY) | |||
Pre-diagnosis cost (cost of scoring questionnaire and risk stratification) | 613.3 (± 50%) | Gamma (15.37, 0.02) | [28] |
LDCT test cost | 239.97 (± 50%) | Gamma (15.37, 0.06) | |
Biopsy diagnosis cost | 1202.9 (± 50%) | Gamma (15.37, 0.01) | |
Lung cancer stage I first year | 83984.91 (± 50%) | Gamma (15.37, 1.83) | Sample survey |
Lung cancer stage I second year and beyond | 19967.12 (± 50%) | Gamma (15.37, 7.70) | Sample survey |
Lung cancer stage II first year | 97435.6 (± 50%) | Gamma (15.37, 1.58) | Sample survey |
Lung cancer stage II second year and beyond | 15888.82 (± 50%) | Gamma (15.37, 9.67) | Sample survey |
Lung cancer stage III first year | 90813.2 (± 50%) | Gamma (15.37, 1.69) | Sample survey |
Lung cancer stage III second year and beyond | 32472.69 (± 50%) | Gamma (15.37, 4.73) | Sample survey |
Lung cancer stage IV first year | 86484.70 (± 50%) | Gamma (15.37, 1.78) | Sample survey |
Lung cancer stage IV second year and beyond | 54962.59 (± 50%) | Gamma (15.37, 2.80) | Sample survey |
Background medical treatment costs | 5348.1 (± 50%) | Gamma (15.37, 0.003) | [35] |
Utility | |||
Utility for healthy smokers without disease (tuberculosis, emphysema, lung cancer), by sex and age | |||
Male, aged 40–50 | 0.99 (0.987–0.994) | Beta (4355.01, 43.99) | [36] |
Male, aged 51–60 | 0.984 (0.980–0.988) | Beta (3872.04, 62.96) | |
Male, aged 61–70 | 0.976 (0.971–0.980) | Beta (3514.87, 86.43) | |
Male, aged \(\ge\) 71 | 0.947 (0.936–0.958) | Beta (1514.71, 84.77) | |
Female, aged 40–50 | 0.988 (0.986–0.991) | Beta (11,257.88, 136.74) | |
Female, aged 51–60 | 0.982 (0.979–0.986) | Beta (7713.61, 141.39) | |
Female, aged 61–70 | 0.964 (0.958–0.971) | Beta (3480.26, 129.97) | |
Female, aged \(\ge\) 71 | 0.936 (0.926–0.946) | Beta (2153.09, 147.22) | |
Disutility associated with tuberculosis | 0.01 (± 50%) | Beta (15.20, 1505.07) | |
Disutility associated with emphysema | 0.052 (± 50%) | Beta (14.51, 264.63) | |
Utility of lung cancer by stage | |||
Lung cancer stage I | 0.85 (0.78–0.89) | Beta (136.78, 24.14) | |
Lung cancer stage II | 0.75 (0.68–0.80) | Beta (149.31, 49.77) | |
Lung cancer stage III | 0.69 (0.56–0.79) | Beta (42.18, 18.95) | |
Lung cancer stage IV | 0.69 (0.38–0.70) | Beta (21.46, 9.64) | |
Disutility associated with a false-positive result | 0.063 (± 50%) for 3 months | Beta (14.33, 213.21) | [42] |
Discount rate | 5% (0–8%) | Triangle (0, 0.05, 0.08) | [43] |