Benefits, harms, and cost-effectiveness of risk model-based and risk factor-based low-dose computed tomography screening strategies for lung cancer: a systematic review

It has been proposed that risk model-based strategies could serve as viable alternatives to traditional risk factor-based approaches in lung cancer screening; however, there has been no systematic discussion. In this review, we provide an overview of the benefits, harms, and cost-effectiveness of these two strategies in lung cancer screening application, as well as discussing possible future research directions. Following the PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Cochrane libraries, and EMBASE from January 1994 to April 2024. Studies comparing risk model-based and risk factor-based low-dose computed tomography(LDCT) screening strategies for lung cancer were included, with data extracted on study characteristics, screening criteria, and outcomes such as sensitivity, specificity, lung cancer deaths averted, false positive, biopsies, overdiagnosis, radiation-related cancer, and cost-effectiveness measures, et al. RESULTS: A total of 16 fulfilled articles were included, comprising 6 model simulation studies, 9 retrospective cohort studies, and 1 interim analysis of a prospective cohort study. Risk model-based strategies generally demonstrated higher sensitivity, comparable specificity and lower radiation-related harms compared to risk factor-based strategies. However, there were variations in life years gained, quality-adjusted life years gained, lung cancer deaths averted and overdiagnosis cases, highlighting the need for optimal risk threshold determination. Risk model-based strategies showed a potential for greater cost-effectiveness, particularly when tailored to individual risk profiles. Furthermore, subgroup analyses revealed a higher net benefit in women, emphasizing the importance of sex-specific eligibility criteria. Risk model-based LDCT screening strategies present a more sensitive and potentially more efficient approach for lung cancer detection. Future research should explore optimal risk thresholds for broader applicability, with attention to sex-specific criteria and individual risk factor dynamics.