Important parameters for cost- effective implementation of lung cancer screening

It is now widely accepted that lung cancer screening through low -dose computed tomography (LDCT) results in fewer diagnoses at a late stage, and decreased lung cancer mortality. Whilst reducing deaths from lung cancer is an essential prerequisite, this must be balanced against the considerable economic costs accumulated in screening. Multiple health economic models have shown substantial variation in cost per Quality-Adjusted Life Year (QALY), partly driven by the healthcare costs in the country concerned and partly by other modifiable programme components. Recent modelling using UK costs and a targeted approach suggest that most scenarios are within the willingness to pay threshold for the UK. However, identifying the most clinically and cost-effective programme is a priority to minimise the total financial impact. Programme components that influence cost-effectiveness include the method of selection of the eligible popu-lation, the participation rate, the interval between rounds of screening, the method of pulmonary nodule management, and the approach to clinical work up. Future research will clarify if a personalised approach to screening, using baseline and subsequent risk to define screening intervals is more cost-effective. The burden of LDCT screening on the medical infrastructure and workforce has to be quantified and carefully managed during implementation.

Automated summary

Low-dose computed tomography (LDCT) for lung cancer screening has been widely accepted for reducing late-stage diagnoses and mortality. However, the economic costs associated with screening need to be considered. Various health economic models have shown significant variation in cost per Quality-Adjusted Life Year (QALY), influenced by healthcare costs and modifiable program components. Recent studies using UK costs suggest most scenarios are within the willingness to pay threshold. Identifying the most clinically and cost-effective program is crucial, considering factors such as population selection, participation rate, screening intervals, nodule management, and clinical workup.