Screening for lung cancer with chest computerized tomography: Is it cost efficient?

Abstract

Despite lung cancer (LC) screening by low-dose computerized tomography (LDCT) gaining many proponents worldwide, for many years it was not recognized as a life-prolonging and cost-effective procedure, until recently. Prospective observational studies had not been able to prove that this screening prolongs survival, but they helped to specify the inclusion and exclusion criteria. Long-awaited results of a prospective, randomized trial finally provided the evidence that LC screening with LDCT can prolong survival of the screened population. Several cost-effectiveness analyses were performed to justify mass introduction of this screening. Results of these analyses are equivocal, although conclusions highly depend upon inclusion and exclusion criteria, methods of analysis and prices of medical procedures which differ between countries as well as the incidence of other pulmonary nodules, especially tuberculosis. Therefore, cost-effectiveness analysis should be performed separately for every country. Cost-effectiveness depends especially upon the rate of false-positive results and the rate of unnecessary diagnostic, screening and treatment procedures. To ensure high cost-effectiveness, LC screening should be performed in accordance with screening protocol, in dedicated screening centers equipped with nodule volume change analysis, or as a prospective non-randomized trial, to ensure compliance with the inclusion and exclusion criteria. To ensure high cost-effectiveness of LC screening, future research should concentrate on determination of high-risk groups and further specifying the inclusion and exclusion criteria.

Keywords: Lung cancer, Non-small cell lung cancers, Screening, Cost-effectiveness, Computerized tomography, Low-dose computerized tomography

Core tip: Results of prospective, randomized trial finally provided the evidence that lung cancer screening with computerized tomography prolongs survival of the screened population. Several cost-effectiveness analyses were performed to justify mass introduction of this screening, but their results differ between countries. Cost-effectiveness depends especially upon the rate of false-positive results which increase the number of unnecessary medical procedures. Therefore, to ensure high cost-effectiveness, lung cancer screening should be performed in accordance with screening protocol, in dedicated screening centers equipped with nodule volume change analysis, or as a prospective non-randomized trial, to ensure compliance with the inclusion and exclusion criteria.