How cost efficient is lung cancer screening?

Little is known about the cost-efficacy of lung cancer screening, which was considered to be a major hurdle for the implementation of a screening project. An actuarial analysis demonstrated, however, that, in the United States, lung cancer screening in high-risk populations would cost insurers less per life-year saved than colorectal, breast, or cervical cancer screening (24). Similar data comes from a study from Israel which showed that baseline LD-CT screening can be performed with relatively low costs per quality-adjusted life-year (QALY) (25). In this study, the estimated cost per QALY gained was as low as $20,000 (25). As health care systems differ significantly between countries, cost-efficacy analyses from one country cannot easily be translated to other countries.

What is the potential risk of the cumulative radiation dose?

The discussion about the potential risk of the cumulative radiation dose in LD-CT lung cancer screening from repeated screening CTs and potential follow-up CTs, has evened out in the last few years. In the NLST, the reported effective dose per screening CT was an average of 1.6 mSv for men and 2.1 mSv for women (25). However, due to the high number of follow-up examinations, the average cumulative radiation dose after three screening rounds added up to 8 mSv (10). This cumulative radiation dose was estimated to cause one cancer death per 2,500 persons screened (10). However, as in the NLST, lung cancer screening was able to improve the overall mortality by 7%; thus, the positive effect of screening outweighs the risk of radiation-induced cancer.


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As modern CT scanners are able to scan the whole chest with less than 1 mSv, and future staging protocols will be performed with a dramatically lower recall rate, the cumulative radiation dose will decrease, and thus, the risk-benefit ratio will further improve.

Conclusions

More data from many different sources provide evidence that LD-CT lung cancer screening can be performed with a higher efficacy if inclusion criteria, as well as nodule management, are optimized. However, to date, only NLST has been able to show the benefits of LD-CT screening with regard to lung cancer and overall mortality. The promising data of the NLST is further supported by analyses, which have demonstrated, that LD-CT lung cancer screening can be performed with even greater efficacy if inclusion criteria as well as nodule management are optimized.

In addition, more and more data provide evidence to overcome potential hurdles in lung cancer screening such as questions regarding the extent of over-diagnosis and potential harms of the cumulative radiation dose. Questions regarding cost-efficiency of lung cancer screening have to be answered for each healthcare system separately.

As most of the data derives from one single study, the NLST, the data, needs to be confirmed, at least in part, by the pooled data of the ongoing European trials.

Acknowledgements
Disclosure: The author declares no conflict of interest.


Helmut Prosch, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna 1090, Austria

Correspondence to: Assoc. Prof. Helmut Prosch. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria. E-mail: [email protected] 


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Source: Translational Lung Cancer Research.