Annual low-dose CT lung cancer screening is recommended for former and current smokers in the U.S., but a new study from the Netherlands claims that it’s not a cost-effective approach. The research published in PLOS Medicine found that limiting screening to high-risk former and current smokers may be better for the bottom line.

The United States Preventive Services Task Force recommends annual LDCT lung cancer screening for individuals between ages 55 and 77 who are current smokers or have quit within the past 15 years, and have a smoking history of at least 30 pack-years.

In February 2015, CMS announced reimbursement for patients who fit that criterion, but other countries are still evaluating the feasibility of implementing lung cancer screening policies. Previous studies that examined the cost-effectiveness of lung cancer screening have historically yielded inconclusive results.
For this new study, researchers at the Erasmus MC University Medical Center Rotterdam used a microstimulation model to analyze 576 different lung cancer screening policies for individuals born between 1940 and 1969 in Ontario, Canada. The data came from the Ontario Health Insurance Plan, Ontario Cancer Registry, smoking behavior surveys and the National Lung Screening Trial.

They investigated how certain screening policy characteristics, including screening starting and stopping ages, screening intervals, and different smoking history eligibility criteria influence the performance and cost-effectiveness of lung cancer screening.

The data revealed that stringent eligibility criteria such as requiring more years of heavy smoking to qualify for screening was more cost-effective than less stringent criteria. The research also revealed that annual screening is more cost-effective than biennial screening.

The most cost-effective scenario involves annual screening for individuals between ages 55 and 75 years who smoked more than 40 pack-years and who quit less than 10 years ago or currently smoke.

It was estimated that this approach would equate to an incremental cost-effectiveness ratio of $41,136 Canadian dollars per life-year gained. It would also reduce lung cancer mortality by 9.05 percent compared to no screening.

The researchers did acknowledge that this scenario would catch fewer lung cancers than the criteria used in the NLST in the U.S. But it would require fewer CT scans, which would lead to fewer false positive screens and lung cancer overdiagnosis.

CT Homepage