Lung cancer screening in Lithuania: a cost-effectiveness analysis

Aim: This study aimed to assess the cost-effectiveness of the annual volumetric-enabled low-dose computed tomography (LDCT) lung cancer screening (LCS), based on the NELSON screening outcomes, versus no screening for the asymptomatic high-risk population in Lithuania. Materials & methods: The previously established model with a decision tree with an integrated state-transition Markov trace was adapted to assess the health benefits and the financial consequences of LCS from the Lithuanian healthcare system perspective. Individuals aged 50-74 years and with a smoking history underwent LCS with LDCT in the screening arm, and it was compared with the absence of screening across a lifetime horizon. The primary outcomes included the clinical benefits (lung cancer cases detected per stage and premature lung cancer deaths averted), direct costs (recruitment, diagnostic and treatment costs) of LCS implementation, quality-adjusted life years, life-years and the incremental cost-effectiveness ratio. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to ascertain the result's robustness. Results: Annual LCS with volumetric-enabled LDCT for 170,808 eligible individuals in Lithuania resulted in 6117 additional early-stage (I and II) lung cancers detected and 1874 averted late-stage (III and IV) lung cancers, leading to 2606 premature lung cancer deaths averted and 21,639 life-years gained at an uptake rate of 46.5%. The incremental cost-effectiveness ratio was €1372 per quality-adjusted life year with incremental costs of €21.1 million and 15,391 quality-adjusted life years gained. The results were robust based on sensitivity and scenario analyses. Conclusion: This study demonstrated that annual LCS with volumetric-enabled LDCT for a high-risk population could be cost-effective compared with no screening in Lithuania.