Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

Carina M Behr; Maarten J IJzerman; Michelle M A Kip; Harry J M Groen; Marjolein A Heuvelmans; Maarten van den Berge; Pim van der Harst; Marleen Vonder; Rozemarijn Vliegenthart; Hendrik Koffijberg

doi:10.1016/j.jtocrr.2025.100813

Model-Based Cost-Utility Analysis of Combined Low-Dose Computed Tomography Screening for Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease

JTO Clin Res Rep. 2025 Feb 19;6(5):100813. doi: 10.1016/j.jtocrr.2025.100813. eCollection 2025 May.

Authors

Affiliations

¹ Health Technology and Services Research, TechMed Centre, University of Twente, Enschede, The Netherlands.
² Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
³ Department of Pulmonary Diseases and Tuberculosis, UMCG - University Medical Center Groningen, Groningen, The Netherlands.
⁴ Department of Epidemiology, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands.
⁵ Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁷ Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁹ Machine Learning Lab, Data Science Center in Health (DASH), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Abstract

Introduction: The conditional cost-effectiveness of low-dose computed tomography for lung cancer (LC) screening has been reported. Extending LC screening to chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), together with Big-3, could increase health benefits at marginal costs. This study aimed to estimate the cost-utility of Big-3 screening compared with no screening and LC screening in The Netherlands.

Methods: A microsimulation model was built to reflect the care pathway, using individual-level data from the National Lung Screening Trial individual-level data, and aggregated data from the literature. The model includes a simulation of the detection of the Big-3 diseases through screening and standard of care. The model also simulated tumor growth and the effects of smoking cessation and treatment. Hypothetical (former) smokers (aged 55-74 y) were simulated according to the National Lung Screening Trial criteria. Individuals with screening-detected diseases receiving (preventative) treatment experience a reduced risk of events and increased survival. A Dutch health system perspective and lifetime horizon were adopted.

Results: Simultaneous LC and CVD screening was the most cost-effective, with incremental costs and effects of €1937 and 0.22 quality-adjusted life-years (QALYs) versus no screening, and €595 and 0.08 QALYs versus LC screening, respectively. This yielded incremental cost-utility ratios of €8561 per QALY and €7154 per QALY versus no screening and LC screening, respectively. LC plus COPD screening was dominated by LC + CVD screening, which yielded lower health benefits and higher costs.

Conclusions: Simultaneous screening for LC + CVD in a high-risk population offers health benefits at low costs compared with no screening or LC screening alone. Adding COPD screening cannot yet be justified owing to the limited clinical evidence.

Keywords: Cardiovascular disease; Chronic obstructive pulmonary disease; Low-dose computed tomography; Lung cancer; Population-based screening.