ArticleBMC medicine2024
Risk-based lung cancer screening in heavy smokers: a benefit-harm and cost-effectiveness modeling study.
Article in BMC medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 3 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 3 syntheses or guidelines pooled it, 5 citations in OpenAlex.
- Cost-Effectiveness and Budget Impact of Lung Cancer Screening: A Systematic Review.PharmacoEconomics · 2026Pooled it
- Cost-effectiveness of lung cancer screening: insights from risk stratification, guidelines, and emerging technologies-a systematic review.NPJ primary care respiratory medicine · 2026Pooled it
- Pooled it
- Interventions for smoking cessation in people undergoing lung cancer screening.The Cochrane database of systematic reviews · 2026Article
- COPD-Lung Cancer Comorbidity: Mechanistic Insights and Precision Oncology Implications.International journal of chronic obstructive pulmonary disease · 2026Review
- Cost-effectiveness of risk model-based lung cancer screening in smokers and nonsmokers in China.BMC medicine · 2025Article
- Cost-effectiveness of low-dose CT screening for non-smokers with a first-degree relative history of lung cancer.BMC public health · 2025Article
- Article
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Authors and funding
14 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAnnual screening through low-dose computed tomography (LDCT) is recommended for heavy smokers. However, it is questionable whether all individuals require annual screening given the potential harms of LDCT screening. This study examines the benefit-harm and cost-effectiveness of risk-based screening in heavy smokers and determines the optimal risk threshold for screening and risk-stratified screening intervals.
methodsWe conducted a comparative cost-effectiveness analysis in China, using a cohort-based Markov model which simulated a lung cancer screening cohort of 19,146 heavy smokers aged 50 ~ 74 years old, who had a smoking history of at least 30 pack-years and were either current smokers or had quit for < 15 years. A total of 34 risk-based screening strategies, varying by different risk groups for screening eligibility and screening intervals (1-year, 2-year, 3-year, one-off, non-screening), were evaluated and were compared with annual screening for all heavy smokers (the status quo strategy). The analysis was undertaken from the health service perspective with a 30-year time horizon. The willingness-to-pay (WTP) threshold was adopted as three times the gross domestic product (GDP) of China in 2021 (CNY 242,928) per quality-adjusted life year (QALY) gained.
resultsCompared with the status quo strategy, nine risk-based screening strategies were found to be cost-effective, with two of them even resulting in cost-saving. The most cost-effective strategy was the risk-based approach of annual screening for individuals with a 5-year risk threshold of ≥ 1.70%, biennial screening for individuals with a 5-year risk threshold of 1.03 ~ 1.69%, and triennial screening for individuals with a 5-year risk threshold of < 1.03%. This strategy had the highest incremental net monetary benefit (iNMB) of CNY 1032. All risk-based screening strategies were more efficient than the status quo strategy, requiring 129 ~ 656 fewer screenings per lung cancer death avoided, and 0.5 ~ 28 fewer screenings per life-year gained. The cost-effectiveness of risk-based screening was further improved when individual adherence to screening improved and individuals quit smoking after being screened.
conclusionsRisk-based screening strategies are more efficient in reducing lung cancer deaths and gaining life years compared to the status quo strategy. Risk-stratified screening intervals can potentially balance long-term benefit-harm trade-offs and improve the cost-effectiveness of lung cancer screenings.
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