Lung Cancer Screening: A Cost-Effective Public Health Imperative

Low-dose CT screening can also identify other modifiable conditions associated with smoking-specifically, chronic obstructive pulmonary disease and coronary artery disease.3 The scan is not invasive or painful, and research shows that the few false-positive results are rarely harmful.4 Markowitz et al.'s article extends the well-established benefits of low-dose CT screening to an occupational hazard cohort; the context is worksite-screening efforts. The particular factors used can vary dramatically by study but generally consider the following. * Cost of the intervention: some screenings (e.g., neonatal genetic testing) may be done once, but for lung cancer, the screening is annual for many years. * Cost of follow-up, including cancer treatment, relative to the status quo. * Effects relative to the status quo, including life extension and avoided treatments: commonly, effects are measured in quality-adjusted lifeyears, a simple ratio that purports to quantify patients' subjective views of outcomes, although we believe that this measure oversimplifies multidimensional values. * Time value of money: discounting future spending to the value of current dollars (present value calculation) is commonly done, but many analyses ignore intractable medical inflation. [...]when the study started, CT scanners were brought to individual worksites on flatbed trucks (an expensive proposition), because low-dose CT technology was not widely available in rural areas; the cost-effectiveness of this study would have greatly improved over time as they transitioned participants to newly established local screening facilities. Because of the limitations of observational and randomized studies, high-quality populationbased cost-benefit and costeffectiveness studies of screening combine data from multiple sources, including real-world data, prices from a relevant payer, and outcomes from observational or randomized trials.