Personalizing lung cancer screening recommendations for heterogeneous populations: a microsimulation study.

Area of Science:

• Pulmonary Medicine
• Preventive Health
• Health Economics

Background:

• Personalizing lung cancer screening (LCS) recommendations is challenging due to varied net benefit.
• Exploring net benefit thresholds can guide personalized LCS decisions.

Purpose of the Study:

• To explore individual and population implications of net benefit thresholds for LCS.
• To compare personalized LCS recommendations with current USPSTF guidelines.

Main Methods:

• Microsimulation used to estimate individualized quality-adjusted life years saved with LCS in a simulated US population (40-80 years old, ever-smokers).
• Identified net benefit thresholds accounting for patient preferences and uncertainties.
• Compared personalized approach to USPSTF guidelines.

Main Results:

• 59 million simulated US adults (40-80, ever-smokers); 15 million USPSTF eligible.
• Half of USPSTF-eligible population shows high net benefit for LCS.
• Current criteria exclude 2.5 million high-net-benefit and 20.5 million intermediate-net-benefit ever-smokers.

Conclusions:

• Half of USPSTF-eligible population could be routinely encouraged for LCS.
• Current LCS eligibility criteria may exclude many high-net-benefit and intermediate-net-benefit ever-smokers.