Cost-Effectiveness of Lung Cancer Screening in a High-Risk Population in Brazil

We aimed to assess whether lung cancer (LC) screening with low-dose computed tomography (LDCT) is cost effective in a high-risk population (current or former smokers-who stopped smoking within <15 years-age 50-80 years, with a smoking history of at least 20 pack-years) in the Brazilian public health setting.

To estimate the size of the population eligible for screening, we used Brazilian 2020 census data and information provided by the nationwide surveillance system of risk factors for chronic diseases. For comparison, we used a nonscreened population of LC cases from the São Paulo state registry. We characterized patient journeys and estimated direct and indirect costs using the nationwide public health system database, DATASUS, and expert opinion from an ad hoc panel. We used Markov models for economic evaluations that considered treatment costs (in Brazilian currency, R$) and outcomes.

Adopting an LC screening strategy with LDCT in this high-risk population would be associated with an incremental cost-effectiveness ratio (ICER) of R$ 133,327 per quality-adjusted life year. For the life year outcome, the ICER was R$ 9,579 per life year gained. For both outcomes, the values were below the cost-effectiveness threshold considered (three times the per-capita gross domestic product, which corresponds to R$ 143,406.06 or $24,735.99 US dollars).

Our study confirms that implementing LC screening with LDCT in a high-risk population is cost effective in the Brazilian public health system.