OBJECTIVES

In a systematic review of economic evaluations for lung cancer screening there were no economic models of the UK setting based on disease natural history. This is a well-recognised modelling approach with advantages in modelling population screening, able to explore the cost-effectiveness of multiple alternative potential programme formats.

METHODS

ENaBL is an individual patient simulation model constructed to test lung cancer screening programme designs. It was based on the observed natural history of lung cancer and calibrated against data from the US National Lung Screening Trial. Costs were taken from the UK Lung Cancer Screening Trial. Participants were simulated current or former smokers aged between 55 and 80 years at a higher risk of lung cancer relative to the general population, from which twelve distinct population subgroups were identified. Each were examined in single, triple, annual and biennial arrangements of screening number and interval length, creating 48 distinct screening strategies. These were compared to no screening. The outcome was incremental cost-effectiveness of strategies.

RESULTS

Low-dose CT screening is predicted to be effective in bringing forward stage distribution at diagnosis and at reducing lung cancer mortality with decreases ranging from 4.2% to 7.7% relative to no screening, depending on screen frequency. Savings in the cost of treatment from earlier detection are outweighed by costs associated with over-diagnosis, and overall healthcare costs are predicted to increase. Single screen programmes targeted at people with ≥3% predicted lung cancer risk in the age ranges 55 to 75 years, and 60 to 75 years produced ICERs of £28,784 and £28,169 per QALY gained, respectively.

CONCLUSIONS

Lung cancer screening may not be cost-effective, depending on the cost-effectiveness threshold used. Thresholds of £20,000 to £30,000 per QALY are commonly used in the UK, and screening may be cost-effective with the higher threshold.