Less Inclusive Lung Cancer Screening Cost-Effective

Computed tomography (CT) lung cancer screening for current or former smokers is currently suggested in the United States and is being considered in other countries as well. The National Lung Screening Trial (NLST) results show that CT screening in such populations with three annual screens can be cost-effective in a trial setting. However, specific criteria, such as smoking history and age, as well as frequency of screening to achieve optimal cost-effectiveness is a topic of debate.

Kevin ten Haaf, department of health, Erasmus MC University Medical Center (Rotterdam, the Netherlands), and colleagues conducted a study to estimate the cost-effectiveness of lung cancer screening in a population-based setting and evaluate the effects of screening eligibility criteria. Researchers used a microsimulation model to analyze 576 different screening policies—differing in age to start and end of screening, smoking eligibility criteria, and screening interval—for individuals born between 1940 and 1969 in Ontario, Canada. Outcome measures included lung cancer deaths averted, life-years gained, percentage screened, costs, and over-diagnosis.

Researchers found that the most cost-effective scenario was annual screening—contrary to prior beliefs of biennial screening being more cost-effective—between ages 55 and 75 years for individuals who smoked more that 40 pack-years (number of packs of cigarettes smoked per day multiplied by number of years of smoking) and who quit smoking less than 10 years ago (or currently smoke). This screening strategy is estimated to reduce lung cancer-specific mortality by 9.05% compared with no screening, with an incremental cost-effectiveness ratio of $41,136 Canadian dollars per life-year gained.

Authors of the study predict these criteria allow for fewer CT scans, which would lead to fewer false-positive screens and overdiagnosis.

Authors acknowledge that their analysis does not account for impact of increased screening frequency and that their assumptions for follow-up procedures were based on data from the NLST, which may not be generalizable to a population setting. Nonetheless, they conclude the study “indicates that lung cancer screening can be cost-effective in a population-based setting if stringent smoking eligibility criteria are applied.” —Zachary Bessette