Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study.

Background: Many health systems are exploring how to implement low-dose computed tomography (LDCT) screening programs that are effective and patient-centered.

Objective: To examine factors that influence when LDCT screening is preference-sensitive.

Design: State-transition microsimulation model.

Data Sources: Two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Target Population: U.S.-representative sample of simulated patients meeting current U.S. Preventive Services Task Force criteria for screening eligibility.

Time Horizon: Lifetime.

Perspective: Individual.

Intervention: LDCT screening annually for 3 years.

Outcome Measures: Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, disutilities (the "degree of dislike") quantifying the burden of screening and follow-up were varied across a likely range. The effect of varying the rate of false-positive screening results and overdiagnosis associated with screening was also examined.

Results of Base-Case Analysis: Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides.

Results of Sensitivity Analysis: Rates of false-positive findings and overdiagnosed lung cancer were not highly influential.

Limitation: The quantitative thresholds that were identified may vary depending on the structure of the microsimulation model.

Conclusion: Identifying circumstances in which LDCT screening is more versus less preference-sensitive may help clinicians personalize their screening discussions, tailoring to both preferences and clinical benefit.

Primary Funding Source: None.