1. Screening for lung cancer with low-dose CT was found to cost ~$81,000 per quality-adjusted life-year (QALY) gained.
Evidence Rating Level: 2 (Good)
Study Rundown: The National Lung Screening Trial (NLST) has shown that screening for lung-cancer with low-dose CT can reduce lung cancer deaths, especially among those at high risk of lung cancer. This study compared the cost-effectiveness of screening with low-dose CT, screening with radiography, and no screening. The authors estimate that CT screening would cost about $1,600 more per person than no screening, and about $1,200 more per person than radiographic screening. These costs include the costs of screening as well as the costs of work-up and treatment of positive results.
The cost per life-year gained through screening was $52,000, while the cost per quality-adjusted life-year (QALY) gained was $81,000. However, these values depend on many of the assumptions made by the investigators and may not apply to implementation of this screening in other contexts.
In-Depth [cost-effectiveness analysis]: The NLST was a large trial that enrolled over 50,000 people in the US and randomized them to annual screening for lung cancer with either low-dose CT or chest radiography. Participants were between 55 and 74 years old with at least a 30 pack-year smoking history. This cost-effectiveness analysis of NLST data estimated the mean life-years, QALYs, costs per person, and incremental cost-effectiveness ratios (ICERs) of screening with low-dose CT, screening with radiography, and no screening. The Short Form Health Survey SF-36 was administered to 11,696 participants and the results were used to adjust life expectancy for quality of life. Estimates of costs per person included both direct medical costs (screening examination, diagnostic workup for positive screening results, and lung cancer treatment) and indirect costs (time and travel). The total costs per person were $3074, $1911, and $1443 for screening with CT, screening with radiography, and no screening, respectively. The ICERs for screening with CT compared to no screening were $52,000 per life-year gained and $81,000 per QALY gained.
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