title: Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review.
abstract: BACKGROUND
  Lung cancer screening with low-dose computed tomography (LDCT) has been shown to deliver appreciable reductions in mortality in high-risk patients. However, in an era of constrained medical resources, the cost-effectiveness of such a program needs to be demonstrated.
  
  
  OBJECTIVE
  The aim of this study was to systematically review the literature analyzing the cost-effectiveness of lung cancer screening using LDCT.
  
  
  METHODS
  We searched MEDLINE, EMBASE, EBM Reviews-Health Technology Assessment, the National Health Service Economic Evaluation Database (NHS-EED), and the Cochrane Database of Systematic Reviews. Due to technological progress in CT, we limited our search to studies published between January 2000 and December 2014. Our search returned 393 unique results. After removing studies that did not meet our inclusion criteria, 13 studies remained. Costs are presented in 2014 US dollars (US$).
  
  
  RESULTS
  The results from the economic evaluations identified in this review were varied. All identified studies reported outcomes using either additional survival (life-years gained) or quality-adjusted life-years (QALYs gained). Results ranged from US$18,452 to US$66,480 per LYG and US$27,756 to US$243,077 per QALY gained for repeated screening. The results of cost-effectiveness analyses were sensitive to several key model parameters, including the prevalence of lung cancer, cost of LDCT for screening, the proportion of lung cancer detected as localized disease, lead time bias, and, if included, the characteristics of a smoking cessation program.
  
  
  CONCLUSIONS
  The cost-effectiveness of a lung cancer screening program using LDCT remains to be conclusively resolved. It is expected that its cost-effectiveness will largely depend on identifying an appropriate group of high-risk subjects.
authors.affiliation: Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Room 4102-2405 Wesbrook Mall, Vancouver, BC, Canada. raymaker@mail.ubc.ca.|Centre for Health Evaluation and Outcomes Sciences (CHEOS), St Paul's Hospital, Vancouver, BC, Canada. raymaker@mail.ubc.ca.
authors.forename: Adam J N
authors.initials: AJN
authors.lastname: Raymakers
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Mayo
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.|Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
authors.affiliation: Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: FitzGerald
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
authors.forename: David G T
authors.initials: DGT
authors.lastname: Whitehurst
authors.affiliation: Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Room 4102-2405 Wesbrook Mall, Vancouver, BC, Canada.|Centre for Health Evaluation and Outcomes Sciences (CHEOS), St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D000069342:Medical Overuse / Q000191:economics* / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D011829:Radiation Dosage; D018570:Risk Assessment / Q000379:methods; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics*