OBJECTIVES: This study aimed to evaluate the cost-effectiveness of lung cancer screening (LCS) with volume-based low-dose computed tomography (CT) versus no screening for an asymptomatic high-risk population in the United Kingdom (UK), utilising the long-term insights provided by the NELSON study, the largest European randomized control trial investigating LCS.

METHODS: A cost-effectiveness analysis was conducted to compare annual LCS with volume CT versus no screening for a lung cancer high-risk population through a cohort simulation, from a UK National Health Service (NHS) perspective. A decision tree was employed to simulate the identification and workup diagnoses for lung cancer patients based on the NELSON study outcomes, while a state-transition Markov model was used to simulate the treatments and long-term survival for lung cancer patients per stage at initial diagnosis. We predicted the number of screen-detected lung cancers, lung cancer mortality, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

RESULTS: Annual volume CT screening resulted in 96,100 more lung cancer cases detected in early stage, and 74,953 fewer cases in late stage, leading to 64,839 premature lung cancer deaths averted, compared to no screening. The total QALYs gained were 386,773 at an incremental cost of approximately £ 3,322 million, resulting in an ICER of £8,589 per QALY, and additional QALYs gained per patient were 2.9. These estimates were robust in the probabilistic sensitivity analysis.

CONCLUSIONS: Annual LCS with volume-based low-dose CT for a high-risk asymptomatic population is cost-effective in the UK from a healthcare system perspective, at a threshold of £20,000 per QALY, representing an efficient use of NHS resources with substantially improved outcomes for lung cancer patients. National LCS is therefore recommended in the UK.