Short Abstract

In 2019, UK lung cancer survival rates hadn't improved in 50 years. NHS England initiated a targeted screening programme for early detection. Ipsos and the Strategy Unit evaluated this, providing real-world delivery insights which helped inform the UK’s decision for national roll-out.

Description

The UK has historically lagged behind comparable countries in cancer survival rates, emphasising the need for earlier diagnosis. In 2019, the NHS set a target to increase early-stage (1 and 2) cancer diagnoses from half to three-quarters by 2028. Lung cancer accounted for 21% of cancer deaths, making it the most common cause of cancer death in the UK, with late-stage diagnosis being a critical issue.

NHS England's Targeted Lung Health Check (TLHC) programme (2019-2024) was initiated to enable earlier lung cancer diagnosis in real-world settings, following positive results from several small-scale trials and pilots.

Ipsos, working with our data partners the NHS Strategy Unit, was commissioned to conduct a process, impact and economic evaluation of the programme. The main objective of the evaluation was to assess whether the encouraging results shown in earlier trials were replicated when the programme was delivered in real world NHS settings. The main outcome of interest was to assess whether there was a shift in cancer staging at diagnosis. We were also tasked with exploring how effectively the programme was delivered, what participants thought of the health checks, and to provide advice on how the programme should be rolled out in future.

During the lifetime of the programme, the UK National Screening Committee recommended that a national lung cancer screening programme should be initiated, and NHS England is now working on national roll-out.

The evaluation showed that 1.22 million invitations were sent, with an overall 44% uptake rate, leading to 324,000 Lung Health Checks and 163,000 CT scans. A total of 2,748 participants received a lung cancer diagnosis, representing a 1.7% conversion rate from initial CT scan. Approximately 75% of these cancers were diagnosed at stages 1 or 2, meeting key benchmarks for early detection. Furthermore, 2,056 other cancers were diagnosed and the programme identified incidental findings in three-quarters of CT scans.

The robust quantitative impact evaluation- which used a Propensity Score Matching and Difference-in-Differences methodology –estimated that an additional 781 lung cancers were diagnosed at stage 1 or 2 that would have otherwise been diagnosed at a later stage or not diagnosed at all. The programme also enabled the detection of an additional 341 lung cancers at stage 3 or 4.

While no immediate impacts were seen on lung cancer mortality rates, this aligns with clinical expectations within the timeframes of the evaluation. Programme challenges included lower participation rates in deprived areas and among ethnic minorities, despite projects reporting delivering engagement strategies to try and address this. However, the programme as a whole was delivered in some of the most deprived areas in England and these areas have therefore disproportionately benefitted. High delivery costs, largely due to staffing, highlighted the complexity and resource demands of implementation, supported by testimonies from various projects.

Insights from the evaluation have been instrumental in shaping the national rollout strategy. NHS England is integrating findings to optimise programme delivery, addressing engagement disparities, driving overall uptake and focusing on engaging the most high-risk individuals.