不同LDCT肺癌筛查频率卫生经济学研究的系统评价

Systematic Review of Health Economics on the Frequency of LDCT Screening for Lung Cancer

目的:回顾和更新目前关于国内外已开展的低剂量计算机断层扫描(low-dose computed tomography,LDCT)肺癌筛查频率卫生经济学评价研究,为LDCT筛查频率的选择及未来研究提供思路和方向。方法:检索PubMed、EMbase、Medline、中国知网和万方数据知识服务平台自建库至2022年12月31日的不同LDCT肺癌筛查频率的卫生经济学研究,并进行系统评价。结果:共纳入12项研究,整体质量较好;在特定的阈值条件下,对吸烟人群和高年龄的普通人群进行肺癌LDCT筛查具有成本效果或效用优势,最佳筛查频率以1年1次和2年1次为主。筛查频率的选择与性别和戒烟干预措施有关,并对LDCT检查的成本和灵敏度、特异度以及与筛查相关的负效用敏感。结论:未来仍需要更多基于长期队列或真实世界研究等检验程度更强的卫生经济学证据确定最佳筛查频率。同时,应针对不同性别人群制定不同筛查频率,并加强人群的戒烟教育和戒烟干预。

Objective:To review and update the current health economic evaluation studies conducted domestically and internationally on frequencies of low-dose computed tomography(LDCT)lung cancer screening,providing ideas and directions for the selection of LDCT screening frequencies and future research.Methods:We reviewed published health economic evaluations on the frequencies of LDCT lung cancer screenings.PubMed,EMbase,Medline,CNKI and WanFang databases were searched for literature retrieval up to December 31,2022.Results:A total of 12 studies were included,and the overall quality was deemed acceptable.LDCT screening for lung cancer in smokers and the elderly was cost-effective under specific threshold,and the optimal screening frequency was annual and biennial.The selection of screening frequency was associated with gender and smoking cessation interventions,and it was sensitive to the cost,sensitivity and specificity of LDCT and screening-related disutility.Conclusion:There is still a need to determine the optimal screening frequency based on more robust health economics evidence such as long-term cohorts or real-world studies.Additionally,the optimal screening frequency should be determined based on gender,and smoking cessation education and interventions should be strengthened.