• The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia. Silvia.Behar-Harpaz@Sydney.edu.au.
• The Daffodil Centre, the University of Sydney, A joint venture with Cancer Council NSW, Sydney, NSW, Australia.
• Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
• Department of Health Sciences, Brock University, St Catharines, ON, Canada.
• Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia.
• Fiona Stanley Hospital, Murdoch, WA, Australia.
• School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

BACKGROUND: A national, lung cancer screening programme is under consideration in Australia, and we assessed cost-effectiveness using updated data and assumptions.

METHODS: We estimated the cost-effectiveness of lung screening by applying screening parameters and outcomes from either the National Lung Screening Trial (NLST) or the NEderlands-Leuvens Longkanker Screenings ONderzoek (NELSON) to Australian data on lung cancer risk, mortality, health-system costs, and smoking trends using a deterministic, multi-cohort model. Incremental cost-effectiveness ratios (ICERs) were calculated for a lifetime horizon.

RESULTS: The ICER for lung screening compared to usual care in the NELSON-based scenario was AU$39,250 (95% CI $18,150-108,300) per quality-adjusted life year (QALY); lower than the NLST-based estimate (ICER = $76,300, 95% CI $41,750-236,500). In probabilistic sensitivity analyses, lung screening was cost-effective in 15%/60% of NELSON-like simulations, assuming a willingness-to-pay threshold of $30,000/$50,000 per QALY, respectively, compared to 0.5%/6.7% for the NLST. ICERs were most sensitive to assumptions regarding the screening-related lung cancer mortality benefit and duration of benefit over time. The cost of screening had a larger impact on ICERs than the cost of treatment, even after quadrupling the 2006-2016 healthcare costs of stage IV lung cancer.

DISCUSSION: Lung screening could be cost-effective in Australia, contingent on translating trial-like lung cancer mortality benefits to the clinic.