Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study

BACKGROUND:

Recommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST).

OBJECTIVE:

To compare the cost-effectiveness of different stopping ages for lung cancer screening.

DESIGN:

By using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT).

DATA SOURCES:

The NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses’ Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator.

TARGET POPULATION:

Current, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort.

TIME HORIZON:

45 years.

PERSPECTIVE:

Health care sector.

INTERVENTION:

Annual LDCT according to NLST, CMS, and USPSTF criteria.

OUTCOME MEASURES:

Incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).

RESULTS OF BASE-CASE ANALYSIS:

The 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates.

RESULTS OF SENSITIVITY ANALYSIS:

Probabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%).

LIMITATION:

Scenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data.

CONCLUSION:

All 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective.