Supplemental Table 1. Inputs – Utility Weights/Quality of Life.
Non-lung
Ages
cancer
20-29
30-39
40-49
50-59
60-69
70-79
80-89
NSCLC states
Females
Males
Source
0.915
0.900
0.868
0.838
0.824
0.786
0.747
0.939
0.910
0.881
0.854
0.841
0.822
0.752
1
Description
Base case
Sources
Post-lobectomy or chemo with CR, no recurrence*
Post-chemo +/- RT with PR or SD, no recurrence
Post-chemo + RT with CR, no recurrence
Any treatment, after recurrence
0.79*
0.79
0.79
0.62
Sensitivity
analyis
0.88*
0.69
0.79
0.52
Post-lobectomy, no recurrence*
Post-chemo +/- RT with SD, no recurrence
Post-chemo +/- RT with PR, no recurrence
Post-chemo +/- RT with CR, no recurrence
Post-lobectomy, after recurrence
Post-chemo +/- RT with SD, after recurrence
Post-chemo +/- RT with PR, after recurrence
Post-chemo + RT with CR, after recurrence
Post-chemo with CR, after recurrence
0.79*
0.79
0.79
0.79
0.31
0.31
0.99
0.83
0.99
0.88*
0.31
0.95
0.99
0.95
0.31
0.31
0.31
0.31
2-4
SCLC states
*Recovery
Months with post-lobectomy utility before return to
3
1, 6, 12,
non-lung cancer
24, never
Abbreviations: CR, complete response; PR, partial response; SD, stable disease; RT, radiotherapy.
1
5-7
Supplemental Table 2. Inputs – CT, Program, Participant, and Treatment Characteristics.
Helical CT
Description
Base Case Value
Source
Value in Sensitivity Analysis
characteristics
Diameter (mm) of
Sensitivity
peripheral* nodules
8
0
0.00
1.0 (perfect for all nodules)
1
0.63
4
0.77
8
1.00
Screen
program
characteristics
Participant
characteristics
Treatment
characteristics
Specificity
1.0 (perfect)
See text
Cost
$283
CPT 71250§
$188
Follow-up protocol
Nodules <4mm
ignored
As in NLST
Serial CT (see text)
Eligibility
Current and former
smokers with
minimum 20 packyears (PY)
Cessation
intervention
effectiveness
Cessation
intervention cost
Effectiveness
n/a
Current and former heavy
smokers (minimum PY = 40);
Current and former smokers
who quit within the last 10
years (minimum PY = 20);
Current heavy smokers
(minimum PY = 40)
4, 8, 16, 30% annual
n/a
$300, $1800
Adherence
100% (perfect)
Background
cessation rate (no
intervention)
3%
9, 10
Cost
See Table 3
SEER-Medicare
1992-2003
See notes below.
70%
8% (0.1 PY), 3% (36 PY),
0.45% (100 PY)¦ 11
Operative mortality
12
Lobectomy
4.0%
3.0%
13
VATS
0.5%
0.2%
14
Mediastinoscopy 0.3%
0.1%
Notes: Mortality reduction is not a model input; screening effectiveness is predicted by the model as a non-linear
function of characteristics of CT examinations, screening program, participants, and treatment effectiveness.
* CT assumed to have lower sensitivity for central nodules (75% of that for peripheral nodules) to account for
obstruction by aorta, etc.; lung cancer cell types vary in proportion central/peripheral.
§ thoracic computed tomography, no contrast media. Base case estimates from 2006 Physician’s Fee Schedule;
sensitivity analysis estimates from the 2006 Hospital Outpatient Prospective Payment System (HOPPS).
¦ selected cessation rates from logistic assuming OR of 1.03 per pack-year, centered at 3% cessation for smokers
with 36 PY.
2
References
1. Hanmer J, Lawrence W, Anderson J, Kaplan RM, Fryback DG. Report of nationally
representative values for the non-institutionalized US adult population for seven health related quality of
life scores. Med Decis Making 2006;26(4):391-400.
2. Earle C, Chapman R, Baker C, Bell C, Stone P, Sandberg E, et al. Systematic overview of
cost-utility assessments in oncology. Journal of Clinical Oncology 2000;18(18):3302-17.
3. Handy JR, Jr., Asaph JW, Skokan L, Reed CE, Koh S, Brooks G, et al. What happens to
patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest.
2002;122(1):21-30.
4. van den Hout WB, Kramer GWPM, Noordijk EM, Leer J-WH. Cost-utility analysis of shortversus long-course palliative radiotherapy in patients with non-small-cell lung cancer. J. Natl. Cancer
Inst. 2006;98(24):1786-94.
5. Yabroff KR, McNeel TS, Waldron WR, Davis WW, Brown ML, Clauser S, et al. Health
limitations and quality of life associated with cancer and other chronic diseases by phase of care.
Medical Care 2007;45(7):629-37.
6. Cannon J, Win T. Long-term quality of life after lung resection. Thorac Surg Clin 2008;18(1):8191.
7. Balduyck B, Hendriks J, Lauwers P, Van Schil P. Quality of life after lung cancer surgery: a
prospective pilot study comparing bronchial sleeve lobectomy with pneumonectomy. J Thorac Oncol
2008;3(6):604-8.
8. McMahon PM, Kong CY, Gazelle GS. Model profiler of the MGH-ITA Lung Cancer Policy
Model. Available from URL: http://cisnet.cancer.gov/profiles/ [accessed May 6, 2010.
9. Centers for Disease Control. Smoking Cessation During Previous Year Among Adults -- United
States, 1990 and 1991. Morbidity and Mortality Weekly Report 1993;42(26):504-07.
10. The Commit Research Group. Community Intervention Trial for Smoking Cessation
(COMMIT): II. Changes in adult cigarette smoking prevalence. American Journal of Public Health
1995;85:193-200.
11. Ashraf H, Tonnesen P, Pedersen JH, Dirksen A, Thorsen H, Dossing M. Smoking habits were
unaffected by CT screening at 1-year fol-low-up in the Danish Lung Cancer Screening Trial (DLCST).
Thorax 2008;64(5):388-92.
12. Bach P, Cramer L, Schrag D, Downey R, Gelfand S, Begg C. The influence of hospital
volume on survival after resection for lung cancer. New England Journal of Medicine 2001;345:181-88.
13. Detterbeck FC, Rivera MP. Clinical presentation and diagnosis. In: Detterbeck FC, editor.
Diagnosis and Treatment of Lung Cancer, Philadelphia, PA: W.B. Saunders Company, 2001.
14. Esnaola N, Lazarides S, Mentzer S, Kuntz K. Outcomes and cost-effectiveness of alternative
staging strategies for non-small-cell lung cancer. Journal of Clinical Oncology 2002;20(1):263-73.
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