Screening for lung cancer with CT: a preliminary cost-effectiveness analysis.

Study Objective: To appraise the potential cost-effectiveness of lung cancer screening with CT.

Study Design: Incremental cost-effectiveness ratios are estimated for two hypothetical cohorts followed up over time. One cohort was screened over the first 5 years of the study period; the other cohort received usual care. Cost streams are projected for each cohort under alternative sets of parameters/ assumptions and from the perspective of national payer groups. Cohort cost differentials arise as a result of screening and variations in stage-specific treatment. Cohort life expectancies are also projected, and they too differ as a consequence of variations in the stage distribution at diagnosis. The ratios of these cost and life-expectancy differences are used to judge the expected economic value of screening.

Results: Results are analyzed for a "worst-case" scenario, ie, with the highest cost and lowest yield assumptions. Under these conditions, screening with CT costs approximately $48,000 per life-year gained, if screening results in 50% of lung cancers detected at localized stage. Smaller proportions of cancer detected at a localized stage result in higher cost-effectiveness ratios, and vice versa.

Conclusion: If screening for lung cancer is effective, it is likely to be cost-effective if the screening process can detect > 50% of cancers at localized stage.