A risk-based lung cancer screening program was more cost-effective than the updated United States Preventive Services Task Force (USPSTF) strategy. These findings were published in the Annals of Internal Medicine.

Lung cancer screening recommendations were updated in 2021 by the USPSTF to start screening at age 50 years for people with a 20 pack-year cumulative smoking exposure.

For this study, a comparative modeling approach with 4 validated microsimulation models was used to evaluate the cost-effectiveness of lung cancer screening strategies in a simulated population of 1,000,000 men and women who had smoking patterns consistent with the 1960 US birth cohort. The USPSTF recommendations were compared with the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial modified 2012 risk prediction model (PLCOm2012) with screening starting at age 50 or 55 years and with 6-year risk thresholds of 0.5% to 2.2%.

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In all categorical age-smoking strategies both the 2021 and 2013 USPSTF recommendations were both more costly and yielded fewer quality-adjusted life years (QALYs) gained compared with risk model-based strategies.

The 1.2% 6-year threshold PLCOm2012 strategy was associated with the highest health benefit, in which each incremental cost-effectiveness ratio cost $94,659 (range, $72,639 to $156,774) per QALY gained. This PLCOm2012 strategy had a similar population screening coverage (21.7% vs 22.6%) but better reduced lung cancer mortality (12.4% vs 11.8%) compared with 2021 USPSTF, respectively.

The risk-based screening programs were also favored in the sensitivity analyses.

This study was limited by using simulated data. These findings should be confirmed using real-world data.

“Lung cancer screening strategies that select persons based on their personal lung cancer risk are robustly more cost-effective than the 2021 USPSTF recommendations. Risk model–based screening is cost-effective under a wide range of risk thresholds, offers flexibility for implementation across different settings, and warrants further consideration,” the study authors concluded.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Toumazis I, Cao P, de Nijs K, et al. Risk model–based lung cancer screening: a cost-effectiveness analysis. Ann Intern Med. Published online February 7, 2023. doi:10.7326/M22-2216