Could chest X-ray screening for lung cancer be cost-effective?

BACKGROUND. Currently, no screening program for lung cancer is advocated, yet recent review of the clinical trials has raised questions about the conclusion that it would not be effective. If a screening program is to be considered, its potential economic impact needs to be assessed. METHODS. An economic model was created comparing lung cancer mortality in male smokers ages 45-80 years, screened versus unscreened. Estimates of the potential reduction in mortality and cost of screening are applied. The outcomes of the model include deaths avoided, life years gained, net casts, and cost-effectiveness. RESULTS. The base analysis (mortality reduction of 18%) estimates that nearly 3000 deaths would be avoided in a population of 100,000 male smokers age 40-80 years, at a cost-effectiveness of $9000 per undiscounted life year gained. A program resulting in only 6% mortality reduction would increase the ratio to $25,000 per undiscounted life years gained. CONCLUSIONS. If further examination of lung cancer screening supports its effectiveness, the results of this model suggest that implementation would be economically efficient. Cancer 2000;89:2502-5. (C) 2000 American Cancer Society.