Modeling the economic impact of a CIZ1B biomarker blood test for lung cancer screening in high-risk populations.

Abstract

e15091 Background: Lung cancer screening using low-dose computed tomography (LDCT) is an established method for reducing lung cancer mortality in high-risk populations. However, LDCT uptake remains as low as 4-6% among eligible Medicare beneficiaries. Barriers such as logistical challenges, fear of false positives leading to invasive tests, and disparities in access limit adoption. This study evaluates the economic implications of incorporating a CIZ1B biomarker blood test into lung cancer screening protocols for Medicare-eligible high-risk populations. The addition of a blood-based biomarker test like CIZ1B could potentially address these barriers by reducing access barriers and unnecessary follow-up procedures, thus increasing screening participation. Methods: An economic impact model was developed to assess the effects of integrating CIZ1B biomarker testing into lung cancer screening for Medicare-eligible high-risk populations. The model incorporated real-world screening uptake, cost estimates, and sensitivity/specificity data for CIZ1B and LDCT. Three implementation scenarios were analyzed: (1) CIZ1B as a primary screen before LDCT, (2) CIZ1B as a second, confirmatory test for LDCT-positive cases, and (3) an expanded screening paradigm in which CIZ1B reduces barriers, increasing overall uptake by 15%. Key inputs included a screening population of 4.9M Medicare beneficiaries, a lung cancer prevalence of 1.5%, and baseline LDCT uptake of 4.6%, increasing to 5.3% in Scenario 3. Sensitivity and specificity for CIZ1B (95%/75–85%) and LDCT (93%/84%) were sourced from published literature and manufacturer data. Cost inputs, inflation-adjusted to 2024 dollars, included LDCT ($241), CIZ1B ($295), follow-up diagnostics ($8,162), and treatment (Stage I: $20,235; Stage IV: $129,977). Modeled outcomes included screenings performed, unnecessary biopsies avoided, net cost impact, and savings from earlier lung cancer detection. Results: Integrating CIZ1B testing in existing protocols could save ~$489M by reducing unnecessary follow-up procedures. Scenario 3, which modeled a 15% increase in screening uptake, projects savings of ~$518M by enabling earlier detection and treatment among an expanded population due to reduction in barriers to screening. These results demonstrate the advantages of a two-step CIZ1B-LDCT approach. Conclusions: The addition of CIZ1B biomarker testing could address key challenges in lung cancer screening by improving access, lowering false-positive rates with a two-pass screening approach, and reducing costs. Expanding screening uptake has potential to save lives and healthcare resources, supporting the need for policy and implementation strategies to promote adoption of this novel biomarker.