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May 14, 2003

Cost-effectiveness of Screening for Lung Cancer

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(18):2357. doi:10.1001/jama.289.18.2357-a

In Reply: The strikingly different arguments posed by Dr Reich, Dr Petty, and Dr Chirikos and colleagues exemplify the debate occurring in lung cancer screening with helical CT.

Reich states that our model has an underlying bias favoring screening and its cost-effectiveness. We did give screening the benefit of the doubt. For example, in our simulation, the screened group experienced both absolute and relative differences in stage distribution. The screened group had fewer advanced-stage cancers with a corresponding increase in the numbers of localized-stage cancers than the nonscreened group. We then incrementally increased the numbers of localized-stage cancers by the degree of length and overdiagnosis biases, which are most prominent in the first year of screening.