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Research impact: how economic analysis informs lung cancer screening policy

While prevention through tobacco control remains the primary investment in further reducing mortality rates due to lung cancer, earlier detection also has great potential to deliver improved outcomes.

This is particularly evident in near future outcomes given that around 50% of individuals diagnosed with lung cancer have already given up smoking.

The gulf between survival at early (stage I) compared with late (stage IV) diagnosis is one of the widest in all cancers, with the five-year relative survival after early diagnosis around 70% while stage IV is only around 3%.

Lung cancer screening can deliver benefits through increased early detection rates, especially when delivered systematically in an organised program supported by accessible and equitable treatment pathways.

Organised cancer screening to date has been implemented for cancers of the bowel, cervix, and breast, through programs that have delivered significant population health gains (informed by evidence published by Daffodil Centre researchers and our research and government partners).

Although our researchers and collaborators have been studying the potential benefits of lung cancer screening for many years, previous government evidence reviews had been unable to show that an organised screening program would deliver more benefits than harms or that screening would be economically beneficial.

This equation began to change as global trial data were released. 

August 2019

Following reports showing the benefits of low dose computed tomography (LDCT) for lung cancer screening within two major international trial settings (the National Lung Screening Trial in the United States and the NELSON Trial in the Netherlands and Belgium), the Australian Government launches an enquiry into the feasibility of an Australian lung cancer screening program. The enquiry is led by Cancer Australia, the Australian Government’s national cancer control agency.

Cancer Australia commissions researchers at the Daffodil Centre to conduct an updated risk factor analysis as part of the enquiry, showing that on current evidence, screening would only benefit populations with a long-term history of tobacco smoking.

November 2020

The Report on the Lung Cancer Screening Enquiry is delivered the Minister for Health, the Hon. Greg Hunt MP.

Late 2021

Cancer Australia adapts its enquiry report into an application to Australia’s independent Medical Services Advisory Committee (MSAC), applying for Medicare support for government-subsidised medical services for lung cancer screening.

April 2022

MSAC releases a public summary highlighting its concerns about a lack of clarity on whether a lung cancer screening program, on the available evidence, would meet cost-effectiveness benchmarks for a public health program supported by Medicare. A recommendation was deferred, pending further analysis.

The MSAC announcement coincides with the submission in the British Journal of Cancer of an updated cost-effectiveness analysis of lung cancer screening in Australia, led by the Daffodil Centre.

October 2022

Daffodil Centre study on updated cost-effectiveness analysis of lung cancer screening for Australia published in the British Journal of Cancer.

MSAC revises their recommendations and supports lung cancer screening, potentially paving the way for a Medicare-funded lung cancer screening program. Health professionals and advocates welcome this announcement, however, the MSAC can only make independent evidence-based recommendations to government.

May 2023

A way forward is confirmed with The Hon Mark Butler, Minister for Health and Aged Care announces the Australian Government’s official support to introduce a national lung cancer screening program from July 2025.

This is a great example of government and nongovernment sectors working together to advance cancer control policy with potential to significantly reduce the burden of Australia’s leading cause of cancer death.

Experience shows that much more needs to be done across all sectors to ensure the program is developed in line with the evidence and is integrated with key areas such as smoking cessation and health services – where the Daffodil Centre will continue to publish and promote independent research evidence designed to inform policy and practice.

Read the research

Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes


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