Original Title: Avis: pertinence du dépistage du cancer du poumon par la tomographie axiale à faible dose

Authors' objectives: Since the publication, in 2011, of the results of a randomized clinical trial (RCT) on low-dose computed tomography (LDCT) lung cancer screening, divergent recommendations regarding the relevance of screening have been published. The Ministère de la Santé et des Services sociaux (MSSS) asked the Institut national d’excellence en santé et en services sociaux (INESSS) to assess the performance, clinical efficacy and safety of LDCT lung cancer screening. The organizational impact of implementing lung cancer screening in Québec and the oversight mechanisms to be put in place in the event of such implementation are also discussed in this report.

Authors' results and conclusions: RESULTS: According to literature data, the uncertainties regarding the incremental cost-effectiveness ratio of screening compared to no screening are high, with some estimates below and other above the thresholds considered socially acceptable. It is the same with the budget impact estimations, which sometimes show savings, sometimes increased health-care costs. Depending on the parameters and assumptions underlying the OncoSim modeling, implementing screening could cost Québec approximately CAD$11.5 million in 2020 and up to CAD$37.3 million in 2029. These estimates do, however, have certain major limitations and depend on the organizational structures chosen. A proper budget impact analysis should be able to rely on up-to-date data on the use of investigations like EBUS or that of treatments like immunotherapy, with respect to which practices are changing quickly. CONCLUSIONS: In short, integrating the scientific and contextual data and the data obtained during consultations revealed a number of concerns regarding the balance between the benefits and risks of screening; the feasibility of recruiting the target population; the costs; the equity of access at the regional level; the possible bottlenecks in the offer of services; and the social acceptability of and relevance time window for LDCT lung cancer screening. In a context where the benefits and risks strongly depend on the organizational and societal context, the wide-scale introduction of LDCT lung cancer screening is clearly not desirable.

Authors' recommendations: INESSS recommends that low-dose computed tomography lung cancer screening be available and accessible only within the context of a rigorous evaluation in a real-world care setting. Such an evaluation would make it possible to estimate the performance of screening, to assess its impact on the health-care system and, ultimately, to rule on the relevance of implementing or not implementing a lung cancer screening program in Québec. Specific recommendations have been made regarding the execution and monitoring of this evaluation phase.

Authors' methods: INESSS conducted public consultations, including with a group of people potentially eligible for lung cancer screening, and discussed the evidence and issues raised by screening with the members of several advisory committees. These consultations brought to light the sensitive situation in which lung cancer screening would be implemented. The socioeconomic and geographic distribution of smoking is uneven, which would present organizational challenges and create tensions between equality, equity of access and service quality. The difficulty in reaching the most vulnerable populations and a possibly weaker participation on their part raises certain concerns over the potential exacerbation of health inequalities. The acceptability of screening by the target population could depend on the mechanisms put in place to maximize the benefits and minimize the risks of screening and to facilitate informed decision-making, but would also depend on personal factors, such as attitude towards health and smoking. The social acceptability of screening might be influenced by the issue of personal responsibility, but also by the opportunity to help populations with vulnerability factors. The importance of investing in smoking prevention and tobacco cessation strategies was stressed repeatedly.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-du-depistage-du-cancer-du-poumon-par-la-tomographie-axiale-a-faible-dose.html

Year Published: 2019

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-du-depistage-du-cancer-du-poumon-par-la-tomographie-axiale-a-faible-dose.html

Requestor: Minister of Health

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec