title: Is chest X-ray screening for lung cancer in smokers cost-effective? Evidence from a population-based study in Italy.
abstract: BACKGROUND
  After implementation of the PREDICA annual chest X-ray (CXR) screening program in smokers in the general practice setting of Varese-Italy a significant reduction in lung cancer-specific mortality (18 %) was observed. The objective of this study covering July 1997 through December 2006 was to estimate the cost-effectiveness of this intervention.
  
  
  METHODS
  We examined detailed information on lung cancer (LC) cases that occurred among smokers invited to be screened in the PREDICA study (Invitation-to-screening Group, n = 5815 subjects) to estimate costs and quality-adjusted life-years (QALYs) from LC diagnosis until death. The control group consisted of 156 screening-eligible smokers from the same area, uninvited and unscreened, who developed LC and were treated by usual care. We calculated the incremental net monetary benefit (INMB) by comparing LC management in screening participants (n = 1244 subjects) and in the Invitation-to-screening group versus control group.
  
  
  RESULTS
  The average number of QALYs since LC diagnosis was 1.7, 1.49 and 1.07, respectively, in screening participants, the invitation-to-screening group, and the control group. The average total cost (screening + management) per LC case was higher in screening participants (€17,516) and the Invitation-to-screening Group (€16,167) than in the control group (€15,503). Assuming a maximum willingness to pay of €30,000/QALY, we found that the intervention was cost-effective with high probability: 79 % for screening participation (screening participants vs. control group) and 95 % for invitation-to-screening (invitation-to-screening group vs. control group).
  
  
  CONCLUSIONS
  Based on the PREDICA study, annual CXR screening of high-risk smokers in a general practice setting has high probability of being cost-effective with a maximum willingness to pay of €30,000/QALY.
authors.affiliation: Department of Economics, University of Verona, Via dell'Artigliere 19, 37129 Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pertile
authors.affiliation: Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Albino
authors.initials: A
authors.lastname: Poli
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dominioni
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rotolo
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Nardecchia
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Castiglioni
authors.affiliation: Department of Radiology, Ospedale S. Antonio Abate, Gallarate, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Paolucci
authors.affiliation: Department of Public Health and Community Medicine, University of Verona, Verona, Italy ; Department of Prevention, Public Health Trust, Trento, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Mantovani
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Imperatori
keywords: Chest X-ray screening; Cost-effectiveness; Cost-utility; Lung cancer