An economic evaluation of lung cancer screening with low-dose computed tomography in a high-risk population of (ex-)smokers in Belgium

Background

Before implementing a screening programme, it is important to balance the benefits against the harms and assess its cost-effectiveness. To date, no such evaluation of lung cancer screening has been conducted in Belgium. The objective of this study was to examine the cost-effectiveness of lung cancer screening using low-dose CT (LDCT) in a Belgian population of (ex-)smokers.

Methods

This economic evaluation is based on the results of the NELSON trial and supplemented with Belgian stage- and histology-specific survival data, Belgian real-world diagnosis and treatment costs, and information from the literature (e.g. quality of life). Incremental costs and effects were modelled by combining a decision tree (invitation, screening and diagnosis) with a Markov model (cancers detected in the intervention and comparator group). The results are expressed as costs per quality-adjusted life years (QALYs). Benefits and harms are also presented on a 1000-person figure.

Findings

Based on the NELSON screening strategy, three rounds of LDCT screening for lung cancer (in years 0, 1 and 3) compared to no screening is associated with an incremental gain of 4.6 QALYs and an incremental cost of €78 000 per 100 participants. This results in an incremental cost-effectiveness ratio of €18 530 per QALY gained.

Interpretation

In the Belgian healthcare setting, LDCT screening of (ex-)smokers for lung cancer is likely to be cost-effective if policy makers are willing to pay more than €20 000 per QALY gained. However, before implementing lung cancer screening, it is important to gain insight into the impact of incidental findings, available budgets, and capacity within the healthcare system. It is also important to evaluate the willingness to participate when individuals are fully informed about the benefits and harms of LDCT lung cancer screening.