title: Cost of a population-based programme of chest x-ray screening for lung cancer.
abstract: BACKGROUND
  After the implementation of a population-based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system.
  
  
  METHODS
  In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting.
  
  
  RESULTS
  Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from euro 607,440 to euro 618,370 (in euros as of 2012), equating to between euro 15,985- euro 16,273 per patient out of the 38 LC deaths averted.
  
  
  CONCLUSIONS
  In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about euro 65,000 per annum, approx. euro 16,000 for each LC death averted.
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese. lorenzo.dominioni@uninsubria.it
authors.forename: L
authors.initials: L
authors.lastname: Dominioni
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese.
authors.forename: N
authors.initials: N
authors.lastname: Rotolo
authors.affiliation: Department of Public and Community Medicine, University of Verona.
authors.forename: A
authors.initials: A
authors.lastname: Poli
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese.
authors.forename: M
authors.initials: M
authors.lastname: Castiglioni
authors.affiliation: Department of Radiology, University of Insubria, Ospedale di Circolo di Varese.
authors.forename: M
authors.initials: M
authors.lastname: Mangini
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese.
authors.forename: M
authors.initials: M
authors.lastname: Spagnoletti
authors.affiliation: Department of Radiology, Ospedale S. Antonio Abate, Gallarate.
authors.forename: M
authors.initials: M
authors.lastname: Paolucci
authors.affiliation: Respiratory Care Unit, Ospedale S. Anna, San Fermo della Battaglia, Como.
authors.forename: A
authors.initials: A
authors.lastname: Paddeu
authors.affiliation: Department of Prevention, Public Health Trust, Trento.
authors.forename: W
authors.initials: W
authors.lastname: Mantovani
authors.affiliation: Division of Pneumology, Fondazione F. Maugeri, IRCCS Rehabilitation Institute of Tradate, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zanini
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo di Varese.
authors.forename: A
authors.initials: A
authors.lastname: Imperatori
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009017:Morbidity / Q000639:trends; D013902:Radiography, Thoracic / Q000191:economics*; D012189:Retrospective Studies