Computed tomography screening for lung cancer in the National Lung Screening Trial: a cost-effectiveness analysis

J Thorac Imaging. 2015 Mar;30(2):79-87. doi: 10.1097/RTI.0000000000000136.


The National Lung Screening Trial (NLST) demonstrated that screening with low-dose CT versus chest radiography reduced lung cancer mortality by 16% to 20%. More recently, a cost-effectiveness analysis (CEA) of CT screening for lung cancer versus no screening in the NLST was performed. The CEA conformed to the reference-case recommendations of the US Panel on Cost-Effectiveness in Health and Medicine, including the use of the societal perspective and an annual discount rate of 3%. The CEA was based on several important assumptions. In this paper, I review the methods and assumptions used to obtain the base case estimate of $81,000 per quality-adjusted life-year gained. In addition, I show how this estimate varied widely among different subsets and when some of the base case assumptions were changed and speculate on the cost-effectiveness of CT screening for lung cancer outside the NLST.

Trial registration: NCT00047385.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Aged
  • Cost-Benefit Analysis*
  • Early Detection of Cancer / economics
  • Female
  • Humans
  • Lung / diagnostic imaging
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / economics*
  • Male
  • Mass Screening / economics
  • Middle Aged
  • Quality-Adjusted Life Years
  • Tomography, X-Ray Computed / economics*
  • United States

Associated data