Abstract

Background and objective. Earlier detection and treatment of lung cancer can significantly improve patient survival rates. This study aimed to assess the cost-effectiveness and budget impact of annual lung cancer screening using low-dose computer tomography, compared to standard care in people aged 55 to 74 identified as being at high risk of lung cancer (PLCOm2012noRace score > 1.5%) in Estonia.
Methods. A simulation model was developed using Estonian statistics, cost data, and data from the first two years of the Estonian lung cancer screening pilot study to assess lung cancer prevalence, mortality, stage distribution, treatment costs, and screening costs. Health effects were measured in qualityadjusted life years, considering both the benefits of screening (i.e. stage shift) and the potential harms (i.e. false positive and negative results, overdiagnosis).
Results. Screening would reduce lung cancer mortality by 13%, but the incremental lifetime cost per screened individual would be 1381 euros. Compared to the standard care, incremental costeffectiveness ratio for annual lung cancer screening was 19,400 euros per qualityadjusted life year. According to budget impact analysis, lung cancer screening would cost an additional 11.8 million euros in the first year and 6.6 million euros annually in subsequent years.
Conclusion. Lung cancer screening is costeffective in Estonia, considering the willingness- to-pay thresholds the state uses.