title: Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: a registry study.
abstract: OBJECTIVE
  Low dose computerised tomography (CT) screening for lung cancer can reduce lung-cancer-specific mortality. The objective of this study was to analyse healthcare costs and healthcare utilisation of participants in the Danish lung cancer CT-screening trial (DLCST).
  
  
  METHODS
  This registry study was nested in a randomised controlled trial (DLCST). 4104 participants, current or former heavy smokers, aged 50-70 years were randomised to five annual low dose CT scans or usual care during 2004-2010. Total healthcare costs and healthcare utilisation data for both the primary and the secondary healthcare sector were retrieved from public registries from randomisation - September 2011 and compared between (1) the CT-screening group and the control group and, (2) the control group and each of the true-positive, false-positive and true-negative groups.
  
  
  RESULTS
  The median annual costs per participant were significantly higher in the CT-screening group (Euros [EUR] 1342, interquartile range [IQR] 750-2980) compared with the control group (EUR 1190, IQR 590-2692) (p<0.0001). When the cost of the CT-screening programme was excluded, there was no longer a statistically significant difference between the CT-screening group (EUR 1155, IQR 567-2798) and the control group (p=0.52). Analyses according to the diagnostic groups showed that annual costs were 10.57 (95% CI 7.09-15.75) times higher for the true-positive and 1.67 (95% CI 1.20-2.32) times higher for the false-positive group compared with the control group.
  
  
  CONCLUSIONS
  Low dose lung cancer CT screening increases healthcare costs compared with no screening; this difference was attributable to the costs of the CT-screening programme. Overall healthcare costs were higher for the true-positive and false-positive groups than for the control group, also when excluding the cost of the CT-screening programme. This increase was outweighed by the larger true-negative group showing no significant differences in costs compared with the control group.
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark. Electronic address: jakobra@sund.ku.dk.
authors.forename: Jakob F
authors.initials: JF
authors.lastname: Rasmussen
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.affiliation: Department of Cardiothoracic Surgery, RT 2152, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Jesper H
authors.initials: JH
authors.lastname: Pedersen
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
authors.forename: Bruno
authors.initials: B
authors.lastname: Heleno
authors.affiliation: Department of Cardiothoracic Surgery, RT 2152, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Saghir
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Brodersen
mesh_terms: D000368:Aged; D003718:Denmark; D055088:Early Detection of Cancer; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012042:Registries; D014057:Tomography, X-Ray Computed
keywords: Cancer early detection; Cancer screening test; Healthcare cost; Lung cancer; Mass screening; Scan spiral CT