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Original Investigation
September 2015

Cost-effectiveness of Lung Cancer Screening in Canada

Author Affiliations
  • 1Department of Oncology, McMaster University, Hamilton, Ontario, Canada
  • 2Statistics Canada, Ottawa, Ontario, Canada
  • 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 4Canadian Partnership Against Cancer, Toronto, Ontario, Canada
  • 5Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
JAMA Oncol. 2015;1(6):807-813. doi:10.1001/jamaoncol.2015.2472

Importance  The US National Lung Screening Trial supports screening for lung cancer among smokers using low-dose computed tomographic (LDCT) scans. The cost-effectiveness of screening in a publically funded health care system remains a concern.

Objective  To assess the cost-effectiveness of LDCT scan screening for lung cancer within the Canadian health care system.

Design, Setting, and Participants  The Cancer Risk Management Model (CRMM) simulated individual lives within the Canadian population from 2014 to 2034, incorporating cancer risk, disease management, outcome, and cost data. Smokers and former smokers eligible for lung cancer screening (30 pack-year smoking history, ages 55-74 years, for the reference scenario) were modeled, and performance parameters were calibrated to the National Lung Screening Trial (NLST). The reference screening scenario assumes annual scans to age 75 years, 60% participation by 10 years, 70% adherence to screening, and unchanged smoking rates. The CRMM outputs are aggregated, and costs (2008 Canadian dollars) and life-years are discounted 3% annually.

Main Outcomes and Measures  The incremental cost-effectiveness ratio.

Results  Compared with no screening, the reference scenario saved 51 000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52 000/QALY. If smoking history is modeled for 20 or 40 pack-years, incremental cost-effectiveness ratios of CaD $62 000 and CaD $43 000/QALY, respectively, were generated. Changes in participation rates altered life years saved but not the incremental cost-effectiveness ratio, while the incremental cost-effectiveness ratio is sensitive to changes in adherence. An adjunct smoking cessation program improving the quit rate by 22.5% improves the incremental cost-effectiveness ratio to CaD $24 000/QALY.

Conclusions and Relevance  Lung cancer screening with LDCT appears cost-effective in the publicly funded Canadian health care system. An adjunct smoking cessation program has the potential to improve outcomes.