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Clinical Investigation: CANCER |

Screening for Lung Cancer With CT*: A Preliminary Cost-effectiveness Analysis

Thomas N. Chirikos, PhD; Todd Hazelton, MD; Melvin Tockman, MD, PhD; Robert Clark, MD
Author and Funding Information

*From the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL.

Correspondence to: Robert Clark, MD, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Dr, Tampa, FL 33612; e-mail: clark@moffitt.usf.edu



Chest. 2002;121(5):1507-1514. doi:10.1378/chest.121.5.1507
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Study objective: To appraise the potential cost-effectiveness of lung cancer screening with CT.

Study design: Incremental cost-effectiveness ratios are estimated for two hypothetical cohorts followed up over time. One cohort was screened over the first 5 years of the study period; the other cohort received usual care. Cost streams are projected for each cohort under alternative sets of parameters/ assumptions and from the perspective of national payer groups. Cohort cost differentials arise as a result of screening and variations in stage-specific treatment. Cohort life expectancies are also projected, and they too differ as a consequence of variations in the stage distribution at diagnosis. The ratios of these cost and life-expectancy differences are used to judge the expected economic value of screening.

Results: Results are analyzed for a “worst-case” scenario, ie, with the highest cost and lowest yield assumptions. Under these conditions, screening with CT costs approximately $48,000 per life-year gained, if screening results in 50% of lung cancers detected at localized stage. Smaller proportions of cancer detected at a localized stage result in higher cost-effectiveness ratios, and vice versa.

Conclusion: If screening for lung cancer is effective, it is likely to be cost-effective if the screening process can detect > 50% of cancers at localized stage.


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