Screening for lung cancer with CT: a preliminary cost-effectiveness analysis.
OBJECTIVE
To appraise the potential cost-effectiveness of lung cancer screening with CT.


METHODS
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.


CONCLUSIONS
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.
Chirikos
Thomas N
TN
H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL 33612, USA.
Hazelton
Todd
T
Tockman
Melvin
M
Clark
Robert
R
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014481:United States