Cost effectiveness analysis of low dose computed tomography lung cancer screening in Chinese population

This study evaluated the economic benefits, optimal starting age, and most appropriate screening strategy for low-dose computed tomography (LDCT) lung cancer screening in the Chinese population from the perspective of the Chinese healthcare system. A Markov model was developed using previously published epidemiological and cost data from China to simulate the screening process for individuals aged 40 to 80. The analysis considered different starting ages (40, 45, 50, and 55 years) and screening intervals (annually, every two years, and every three years), resulting in 12 screening strategies and one no-screening strategy. The primary outcome was the incremental cost-effectiveness ratio (ICER). To validate the model, predicted lung cancer incidence rates were compared with actual incidence data from China, and the results showed consistency. The analysis identified age 55 as the optimal starting point for screening, with the strategy of screening every three years from age 55 to 80 emerging as the most cost-effective. Age 55 was thus determined to be the most appropriate starting age for initiating LDCT screening. This strategy yielded an ICER well below the per capita GDP of China in 2019, which was used as the willingness-to-pay (WTP) threshold in this study. One-way sensitivity analysis highlighted the cost of LDCT screening as the most influential parameter affecting the ICER. Probabilistic sensitivity analysis further confirmed the robustness of the findings: at a WTP threshold equal to the 2019 per capita GDP of China (71,453 CNY/QALY), the strategy of screening every three years from age 55 to 80 was cost-effective in nearly all simulations compared with no screening. In conclusion, when using the per capita GDP of China in 2019 as the WTP threshold, the optimal lung cancer screening strategy for the Chinese population was triennial LDCT screening from age 55 to 80. Sensitivity analyses consistently supported the robustness of this strategy's cost-effectiveness.