title: Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: the Israeli experience.
abstract: OBJECTIVE
  Reduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel.
  
  
  METHODS
  A decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases-lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated.
  
  
  RESULTS
  Base-case incremental cost per QALY gained was $1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than $10,000 with probability 0.937 and is lower than $20,000 with probability 0.978.
  
  
  CONCLUSIONS
  Our analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.
authors.affiliation: The Braun Hebrew University-Hadassah School of Public Health, Jerusalem, Israel. Electronic address: amirsh@ekmd.huji.ac.il.
authors.forename: Amir
authors.initials: A
authors.lastname: Shmueli
authors.forename: Shifra
authors.initials: S
authors.lastname: Fraifeld
authors.forename: Tamar
authors.initials: T
authors.lastname: Peretz
authors.forename: Orit
authors.initials: O
authors.lastname: Gutfeld
authors.forename: Maya
authors.initials: M
authors.lastname: Gips
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: Dorith
authors.initials: D
authors.lastname: Shaham
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007557:Israel; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods*
keywords: Israel; cost per QALY; low-dose computed tomography; lung cancer