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Cost-Effectiveness and Budget Impact of Lung Cancer Screening: A Systematic Review
Nuo Chen1,2, Siyuan Wang3,4, Jing Bai1,5
1Dong Fureng Institute of Economic and Social Development, Wuhan University, Room A201, Wuhan, 430000, Hubei, China.
Introduction:
Clinical trials have demonstrated the benefits of early detection of lung cancer (LC); however, the implementation of national LC screening programs remains under consideration. Economic evaluations provide evidence-based insights to support informed policy decisions.
Objectives:
This systematic review aims to comprehensively synthesize the health economic evidence on LC screening and examine the methodological challenges.
Methods:
We searched six databases from inception to July 31, 2025. Articles were included if evaluating LC screening using a full economic evaluation and/or budget impact analysis (BIA). The Criteria for Health Economic Quality Evaluation (CHEQUE) tool was used for quality assessment of full economic evaluations. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were modified as a quality checklist for BIA studies. Narrative synthesis was conducted to summarize the included studies.
Results:
Ninety-five articles were identified, representing 93 full economic evaluations and nine BIAs. Seventy-nine full economic evaluations supported the cost-effectiveness of LC screening, while five indicated it was not cost-effective. Seventy studies evaluated low-dose computed tomography (LDCT) screening compared with no screening. Twelve studies considered emerging technologies either as standalone screening modalities or as adjuncts to LDCT screening, including artificial intelligence, genomics, and biomarkers. All BIAs assessed an LDCT-based screening program. Eight studies found that it would increase the budget, while one reported the opposite. All included studies demonstrated substantial methodological variation, including differences in the definition of eligible populations, modeling approaches, assumed uptake rates, cost components, sources of utility values, and equity consideration.
Conclusion:
Our review suggests that LDCT screening is generally cost-effective in high-risk populations, although implementing LC screening programs may entail a substantial budgetary impact. Emerging technologies, novel therapies, and combined screening have the potential to improve screening efficiency. Future economic evaluations are needed to assess these advances, while addressing existing methodological challenges to improve alignment between evidence. This review provides up-to-date economic evidence on LC screening and offers policymakers a clearer understanding of its financial implications.
