title: Biennial lung cancer screening in Canada with smoking cessation-outcomes and cost-effectiveness.
abstract: Guidelines recommend low-dose CT (LDCT) screening to detect lung cancer among eligible at-risk individuals. We used the OncoSim model (formerly Cancer Risk Management Model) to compare outcomes and costs between annual and biennial LDCT screening.
  
  
  
  OncoSim incorporates vital statistics, cancer registry data, health survey and utility data, cost, and other data, and simulates individual lives, aggregating outcomes over millions of individuals. Using OncoSim and National Lung Screening Trial eligibility criteria (age 55-74, minimum 30 pack-year smoking history, smoking cessation less than 15 years from time of first screen) and data, we have modeled screening parameters, cancer stage distribution, and mortality shifts for screen diagnosed cancer. Costs (in 2008 Canadian dollars) and quality of life years gained are discounted at 3% annually.
  
  
  
  Compared with annual LDCT screening, biennial screening used fewer resources, gained fewer life-years (61,000 vs. 77,000), but resulted in very similar quality-adjusted life-years (QALYs) (24,000 vs. 23,000) over 20 years. The incremental cost-effectiveness ratio (ICER) of annual compared with biennial screening was $54,000-$4.8 million/QALY gained. Average incremental CT scan use in biennial screening was 52% of that in annual screening. A smoking cessation intervention decreased the average cost-effectiveness ratio in most scenarios by half.
  
  
  
  Over 20 years, biennial LDCT screening for lung cancer appears to provide similar benefit in terms of QALYs gained to annual screening and is more cost-effective. Further study of biennial screening should be undertaken in population screening programs. A smoking cessation program should be integrated into either screening strategy.
authors: Department of Oncology, McMaster University, 699 Concession St., Hamilton, ON, L8V 5C2, Canada. Electronic address: goffin@mcmaster.ca.
authors: John R
authors: JR
authors: Goffin
authors: Statistics Canada, Ottawa, ON, K1A 0T6, Canada. Electronic address: Bill.Flanagan@canada.ca.
authors: William M
authors: WM
authors: Flanagan
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. Electronic address: ab.miller@sympatico.ca.
authors: Anthony B
authors: AB
authors: Miller
authors: Canadian Partnership Against Cancer, 1 University Ave., Suite 300, Toronto, ON M5J 2P1, Canada. Electronic address: Natalie.Fitzgerald@partnershipagainstcancer.ca.
authors: Natalie R
authors: NR
authors: Fitzgerald
authors: Canadian Partnership Against Cancer, 1 University Ave., Suite 300, Toronto, ON M5J 2P1, Canada. Electronic address: saima.memon@partnershipagainstcancer.ca.
authors: Saima
authors: S
authors: Memon
authors: Department of Epidemiology and Community Medicine, University of Ottawa, 600 Peter Morand Crescent, Room 301 K, Ottawa, ON, K1G 5Z3, Canada. Electronic address: michael.wolfson@uottawa.ca.
authors: Michael C
authors: MC
authors: Wolfson
authors: Department of Oncology, McMaster University, 699 Concession St., Hamilton, ON, L8V 5C2, Canada. Electronic address: Bill.Evans@cancercare.on.ca.
authors: William K
authors: WK
authors: Evans
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011829:Radiation Dosage; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D000074606:Smoking Prevention; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*
keywords: Cost-effectiveness; Low-dose CT; Lung cancer; Screening; Smoking cessation