Performing a high-resolution CT on non-smoking women age 24 to 53 with a collapsed lung can be a cost-effective screening for lymphangioleiomyomatosis (LAM), according to a study published online Feb. 18 in the American Journal of Respiratory and Critical Care Medicine.
LAM, a rare lung disease, occurs when cells begin to grow and spread to the lungs, kidneys, lymph nodes and vessels. "Women with LAM who first experience spontaneous lung collapse will, on average, experience two more,” according to Brent Kinder, MD, the study's senior investigator.
Kinder and colleagues of the University of Cincinnati in Ohio evaluated the cost-effectiveness of screening patients for LAM by evaluating the rates of spontaneous pneumothorax and the prevalence of LAM in relation to age, gender and smoking status. The researchers used 2007 Medicare data.
According to the authors, the prevalence of LAM in non-smoking women between the ages of 25-54 with spontaneous pneumothorax is estimated at 5 percent, based on available literature.
“We thought that targeting screening to non-smoking women in the age range of typical LAM development may help us identify the condition earlier and improve quality of life for these patients," said Kinder.
After evaluating the costs and benefits of high-resolution CT screening, results showed that use of CT scanning produced a cost-effectiveness ratio of $32,980 per quality adjusted life-year (QALY) gained.
Based on a sensitivity analysis, the researchers said that the study was "most affected by changes in the probability of diagnosing LAM based on high-resolution CT findings alone." They wrote that if LAM was diagnosed with and biopsy could be avoided, the high-resolution CT screening would offer $15,679 per QALY gained. The sensitivity analysis also showed that high-resolution CT screening remains cost-effective for groups in which the prevalence of LAM in the population subset screened is greater than 2.5 percent.
“We believe the benefits of testing outweigh any negative impact on patients with LAM. The radiation dose of a high-resolution CT scan is approximately one-tenth of conventional CT scans, and with newer technology, the radiation exposure continues to decrease,” said Kinder.
The study was funded by the National Institutes of Health clinical research loan repayment grant.