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In this study a computer simulated model of a hypothetical cohort of 100 000 60 year old current, quitting, and former smokers was used to assess the cost effectiveness of helical CT lung cancer screening. Using the best available data on outcomes associated with lung cancer screening, the costs of diagnosis, treatment and long term outcomes, the efficacy of changing the clinical stage distribution of lung cancer so that the screened group would have fewer advanced staged cancers and more localised stage cancers was assessed. Biases such as lead time (from earlier onset of costs as a result of earlier diagnosis), length (due to long latency periods), and overdiagnosis (for example, of subclinical disease) were incorporated. Over 20 years there were 553 fewer lung cancer deaths and 1186 false positive invasive tests in the screened group. The incremental cost for current, quitting, and former smokers was $116 300, $558 600, and $2 322 700 per quality-adjusted life year (QALY) gained, respectively. Even the most favourable parameters estimated the most cost effective outcome for current smokers to be $42 500 per QALY.
The debate on the usefulness of helical CT scanning to screen for lung cancer rages on. The National Cancer Institute has recently initiated a large randomised trial to assess the efficacy of helical CT screening for detection of early lung cancer. While the results of this trial are awaited, commercially available cancer screening programmes are being widely promoted in the US. Mahadevia and colleagues have used complex analysis techniques to suggest that screening is not cost effective with current methods.
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