Estimating stage-specific lung cancer costs for economic evaluation of LDCT screening in Ireland: a patient-level microsimulation.

BACKGROUND

Lung cancer imposes a significant clinical and economic burden in Ireland, with low five-year survival rates and no national low-dose computed tomography (LDCT) screening. Stage-specific cost estimates are essential for economic evaluation but are lacking, particularly as novel, high-cost therapies shift treatment patterns. This study estimates stage-stratified lung cancer costs over five years from the Irish public payer perspective.

METHODS

A patient-level microsimulation model was developed using data from the National Cancer Registry Ireland, Health Pricing Office tariffs, and published literature. Individual treatment pathways and lines of care were modelled by stage. Progression-free survival was estimated parametrically. Costs (2024 euro) were assigned monthly and summarized as mean cost per patient. Uncertainty was assessed via probabilistic and one-way sensitivity and scenario analyses.

RESULTS

Five-year costs per surviving patient increased with stage, ranging from €38,149 (Stage I) to €231,723 (Stage IV). Year 1 represented the highest cost component, peaking at €62,869 for Stage IV. While costs declined after Year 1 in early-stage disease, they remained high in Stage IV (~€28,489 in Year 5) due to ongoing systemic therapy. Sensitivity analyses identified immunotherapy prices as the primary cost driver in advanced stages, while surgery costs were most influential in Stages I-II. Annual lung cancer costs in Ireland were estimated at ~€120 million.

CONCLUSIONS

Lung cancer costs in Ireland are heavily stage-dependent. The cost differential between early and advanced disease supports the economic rationale for LDCT screening to facilitate stage shift. These findings provide critical inputs for evaluating a national risk-based screening programme.