Table 4

Comparison of cost-effectiveness approaches used in the National Lung Cancer Screening Trial (NLST) and UK Lung Cancer Screening(UKLS)

UKLSNLST16Consequence (USA compared with the UK)
1Yield=2.1% of persons screenedYield=2.0% of persons screenedSimilar yield
2Single prevalence screen.
Screening and workup costs per person=£212=$327 at current exchange rates (7 July 2015)
3 screens to produce similar yield
Screening and workup costs per person screened=$1965 (table 2)
  • Far more resources devoted to initial detection in USA

  • Any US resource has a higher unit cost

3Net treatment costs per person (screen-detected vs no screening)=£60=$92Net treatment costs per person (screen detected vs no screening)=$175US costs treatment costs higher
4Costs of patient time and travel to appointments are NOT included in total costs:
  • the evaluation adopts an NHS perspective, as recommended by NICE

Costs of patient time and travel to appointments are included in total cost:
  • the evaluation adopts a social perspective, as recommended by the US Panel on Cost-Effectiveness in Health and Medicine

Inclusion of patient costs makes US screening and management appear to be more expensive (and less cost effective)
5Outcome estimate calculations based on life table survival estimatesOutcome estimates calculations based on life table survival estimatesSimilar life table survival estimation method used in both trials
6Incremental quality adjusted life years (QALYs) gained per person screened=0.03Incremental QALYs gained per person screened=0.02 overall, but 0.03 in the age range 60–69Gains per person screened appear essentially similar
7UKLS modelling based on 1 year
£8466 per QALY gained (CI £5542 to £12 569)
$13 071 per QALY gained (CI $8556 to $19 405)
$81 000 per QALY gained (5% CI 52 000 to 186 000).
Calculations based on quintiles 4 and 5, accounts for a significantly higher proportion of the lung cancer deaths: costings: 4th quintile $32,000/QALY; 5th quintile $52,000/QALY (ie, £20,921; £33,996)
Allowing for the fact that the medical care in the USA is more expensive than the UK, the NLST ICER would be at least halved, if the screening had been confined to the two highest risk quintiles
  • NICE, National Institute for Health and Care Excellence.