The Optimal Lung Cancer Ct Screening Strategy: A Cost-Effectiveness Study Incorporating Nelson Evidence, Evolving...

Lung cancer screening implementation is taking shape worldwide. Programme design requires specifying eligibility criteria, screening interval, and the optimal age range. We estimate benefits and harms of competing strategies, integrating NELSON results, smoking cessation interventions, contemporary treatment costs, and the management of feasible CT capacity. 1080 strategies are evaluated using the MISCAN-Lung microsimulation model, calibrated to NELSON and NLST data. 1945-1979 Dutch cohorts are simulated using a representative smoking history generator. For each strategy, the (cost-)effectiveness is evaluated, as well as CT requirements and the incremental benefit of a smoking cessation intervention (pharmacotherapy). Lung cancer screening was found to be cost-effective overall. Risk-based recruitment (PLCOm2012) is more efficient than pack-year-based criteria. Annual screening ages 55-75 from > 1.5% lung cancer risk is cost-efficient (ICER < €20 k), and would cost €12,201 per quality-adjusted life-year (QALY) relative to no screening (or €19,713 compared to less intensive screening). Population-wide, lung cancer mortality would be reduced by 10.8% (1072 cases/year) at full uptake, or by 6.2% at 50% uptake. For the first three years, at 50% uptake of screening, the strategy requires a 16.1% increase of national CT volume. Nearly half of CT costs are offset by reductions in terminal care expenditures. Integrated smoking cessation is cost-effective at €10,043/QALY (relative to screening without integrated cessation), yielding 32% additional life-years gained. Lung cancer screening is increasingly cost-effective and may be critically considered for implementation, including integrated smoking cessation. We find annual screening ages 55-75 for those > 1.5% (PLCOm) risk to be within a €20 k willingness-to-pay and feasible CT requirements.