Cost of a 5-year lung cancer survivor: symptomatic tumour identification vs proactive computed tomography screening

BACKGROUND: Our objective was to analyse the cost effectiveness of computed tomography (CT) screening for lung cancer in terms of the cost per long-term survivor, which has not been evaluated to date. METHODS: Estimations were computed based on data from the Surveillance, Epidemiology, and End Results registries covering years 1999-2003. The design framework of our model allowed for the incorporation of multiple values taken from the epidemiological and clinical literature to be utilised for cost inputs, scope of patients screened, diagnostic staging, and survival percentages applied separately to two cohorts: age 40-79 and 60-79 years. This enabled the analysis of over 1400 scenarios, each containing a unique set of input values, for which the estimated cost per 5-year survivor (CP5YS) was compared between the symptom-detected and proactive screening approaches. RESULTS: Estimated CP5YS were higher for the symptom-detected approach in all 729 scenarios analysed for the cohort ages 60-79 years, ranging from approximately $5800 to $116700 increased cost per 5-year survivor (CP5YS). For the cohort ages 40-79 years, 75% of the 729 scenarios analysed showed increased CP5YS for the symptom-detected approach ranging from $5700 to $110000 increased CP5YS. Total costs and total 5-year survivors were higher for the proactive screening method for all scenarios analysed across both cohorts with increases ranging from 50-256% and 98-309%, respectively. CONCLUSION: The predicted increase in long-term survival with CT screening and the potential for better utilisation of health-care dollars in terms of CP5YS, particularly when screening patients over the age of 60 years, are critically important considerations in directing effective future lung cancer management strategy. British Journal of Cancer (2009) 101, 882-896. doi:10.1038/sj.bjc.6605253 www.bjcancer.com Published online 18 August