OBJECTIVES: Lung cancer is the leading cause of cancer related mortality in North America. This is attributable to it often being diagnosed at an advanced stage. Low dose computed tomography (LDCT) is a tool that can be used to potentially detect lung cancer at an earlier stage thereby improving patient outcomes. Recently, the National Lung Screening Trial (NLST) has shown that this method of screening can produce significant mortality reductions; however, whether such a program is cost-effective has not yet been well-established. METHODS: We searched MEDLINE, EMBASE, EBM Reviews - Health Technology Assessment, the National Health Service (NHS) Economic Evaluation Database, and the Cochrane Database of Systematic Reviews. We included studies that presented a cost-effectiveness analysis of LDCT as a method of screening for lung cancer. Studies published prior to 2000 were excluded based on advances in imaging technologies. Costs are presented in 2012 United States dollars.  RESULTS: Thirteen studies were identified that met the criteria for inclusion. Ten studies were from the United States, and one each from Australia, Israel, and Japan. Most studies evaluated an annual screening program while four studies evaluated one time only screening. Incremental cost-effectiveness ratios (ICERs) were extracted for comparison and varied markedly between $8 186/LYG to $195 758/LYG (life year gained) or for quality-adjusted life years (QALYs): $1 494/QALY to $150 772/QALY. The model results seemed to be sensitive to several parameters including: the prevalence of lung cancer, the cost of LDCT screening, inclusion and characteristics of a smoking cessation program, the stage at which lung cancer was detected, and the lead-time associated with screening. Only one identified study conducted probabilistic sensitivity analysis.  CONCLUSIONS: The cost-effectiveness of a lung cancer screening program varies widely and seems to largely depend on several key model parameters. Improved risk stratification might enhance the cost-effectiveness of such a program.