title: Computed tomography screening for lung cancer in the National Lung Screening Trial: a cost-effectiveness analysis.
abstract: The National Lung Screening Trial (NLST) demonstrated that screening with low-dose CT versus chest radiography reduced lung cancer mortality by 16% to 20%. More recently, a cost-effectiveness analysis (CEA) of CT screening for lung cancer versus no screening in the NLST was performed. The CEA conformed to the reference-case recommendations of the US Panel on Cost-Effectiveness in Health and Medicine, including the use of the societal perspective and an annual discount rate of 3%. The CEA was based on several important assumptions. In this paper, I review the methods and assumptions used to obtain the base case estimate of $81,000 per quality-adjusted life-year gained. In addition, I show how this estimate varied widely among different subsets and when some of the base case assumptions were changed and speculate on the cost-effectiveness of CT screening for lung cancer outside the NLST.
authors: Department of Radiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: William C
authors: WC
authors: Black
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014481:United States
references: J Med Screen. 2008;15(3):153-8
references: 18927099
references: J Am Coll Radiol. 2015 Mar;12 (3):273-6
references: 25176499
references: Br J Cancer. 2010 Jan 5;102(1):27-34
references: 19935789
references: Chest. 2003 Aug;124(2):614-21
references: 12907551
references: J Health Econ. 2002 Mar;21(2):271-92
references: 11939242
references: Cancer. 2014 Nov 1;120(21):3401-9
references: 25065710
references: Med Care. 2007 Dec;45(12):1162-70
references: 18007166
references: Can Assoc Radiol J. 2011 May;62(2):141-5
references: 20382501
references: Health Econ. 1997 Jul-Aug;6(4):327-40
references: 9285227
references: Lung Cancer. 2001 Jun;32(3):227-36
references: 11390004
references: J Am Coll Radiol. 2010 Oct;7(10 ):754-73
references: 20889105
references: N Engl J Med. 2014 Nov 6;371(19):1793-802
references: 25372087
references: J Thorac Oncol. 2011 Nov;6(11):1841-8
references: 21892105
references: BMC Health Serv Res. 2006 Apr 19;6:52
references: 16623946
references: J Natl Cancer Inst. 2010 May 5;102(9):605-13
references: 20413742
references: JAMA. 2003 Jan 15;289(3):313-22
references: 12525232
references: Lung Cancer. 2005 May;48(2):171-85
references: 15829317
references: Health Aff (Millwood). 2012 Apr;31(4):770-9
references: 22492894
references: N Engl J Med. 2014 Aug 28;371(9):796-7
references: 25162885
references: N Engl J Med. 2013 Feb 21;368(8):728-36
references: 23425165
references: Cancer. 2013 Nov 15;119(22):3976-83
references: 24037918
references: Ann Intern Med. 2014 Nov 4;161(9):627-33
references: 25199624
references: Health Econ. 1996 Sep-Oct;5(5):470-2
references: 8922973
references: Ann Intern Med. 2014 Mar 4;160(5):330-8
references: 24378917
references: J Am Coll Radiol. 2010 Dec;7(12 ):943-8
references: 21129685
references: JAMA. 2011 Nov 2;306(17 ):1865-73
references: 22031728
references: Ann Intern Med. 2014 Mar 4;160(5):363-4
references: 24379025
references: Ann Intern Med. 2012 Dec 4;157(11):776-84
references: 23208167
references: Ann Intern Med. 2014 Mar 4;160(5):311-20
references: 24379002
references: JAMA Intern Med. 2014 Feb 1;174(2):269-74
references: 24322569
references: N Engl J Med. 2011 Aug 4;365(5):395-409
references: 21714641
references: Natl Vital Stat Rep. 2014 Jan 6;62(7):1-63
references: 24393483
references: JAMA. 1996 Oct 9;276(14):1172-7
references: 8827972
references: J Med Screen. 2012 Sep;19(3):154-6
references: 23060474
references: Clin Lung Cancer. 2013 Mar;14 (2):139-48
references: 22868220
references: JAMA. 2012 Jun 13;307(22):2418-29
references: 22610500