Cost-Effectiveness Comparison of Screening Options for Lung Cancer Based on Randomized Population Trials
A cost-effectiveness analysis of computed tomography (CT) screening using National Lung Screening Trial (NLST) data concluded that CT was generally cost-effective. However, that analysis was performed under the assumption that chest x-ray (CXR) screening only added costs without benefit. An independent analysis of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), which compared CXR with no screening, found that CXR screening has a highly significant lung cancer survival advantage. Because CXR is less expensive than CT with a lower false-positive rate, researchers explored its cost-effectiveness relative to CT based on data from PLCO and NLST. The NLST-eligible subset of PLCO was also used to facilitate comparison of no screening, CXR, and CT.
Analysis of PLCO data demonstrate that CXR compared with no screening was associated with a gain of 0.0152 life-years per person at an additional cost of $243 per-person. The total cost per life-year gained is then $19,175. In the NLST-eligible subset of PLCO, CXR cost an additional $350 with a gain of 0.0262 life-years per person. The total cost per life-year gained is then $13,377. In NLST, CT compared with CXR cost an additional $1181 per person and with a gain of 0.0157 life-years per person ($75,180 per life-year gained). Using the NLST-eligible subset of PLCO for comparison, the ratio for CT compared with no screening was $36,552.
Researchers concluded that CT screening is both effective and cost-effective; it continues to represent the optimal method of lung cancer screening. However, the survival advantage associated with CXR screening relative to no screening and its relatively low cost suggest that CXR is a reasonable alternative to CT, particularly in regions of the world where access to CT screening is limited.
Flores JPE, et al. WCLC 2016. Abstract MA 03.05. ID 5516.