Selection of individuals for lung cancer screening based on risk prediction model performance and economic factors – The Ontario experience

•Lung cancer screening eligibility determined by Health Technology Assessment (HTA) and MISCAN microsimulation model vs. PLCOm2012 model.•PLCOm2012 had significantly higher sensitive and PPV compared to the preferred cost-effective MISCAN model.•Expert panel choose the PLCOm2012noRace model for deciding eligibility into the Ontario Health - Cancer Care Ontario lung screening Pilot.•Navigators PLCOm2012 risk assessed efficiently. Doctors preferred it. Participants rated it highly. Navigators reported no problems.•Pilot PLCOm2012 led to significantly higher cancer detection than in NLST and NELSON, with significant shift to early stage. Randomized controlled trials have shown that screening with computed tomography reduces lung cancer mortality but is most effective when applied to high-risk individuals. Accurate lung cancer risk prediction models effectively select individuals for screening. Few pilots or programs have implemented risk models for enrolling individuals for screening in real-world, population-based settings. This report describes implementation of the PLCOm2012 risk prediction model in the Ontario Health (Cancer Care Ontario) lung cancer screening Pilot. In the Pilot’s Health Technology Assessment, 576 categorical age/pack-years/quit-years scenarios were evaluated using MISCAN microsimulation modeling and cost-effectiveness analyses. A preferred model was selected which provided the most life-years gained per cost. The PLCOm2012 was compared to the preferred MISCAN scenario at a threshold that yielded the same number eligible (risk ≥2.0 %/6-years). The PLCOm2012 had significantly higher sensitivity and predictive value (68.1 % vs 59.6 %, p