| dc.description.abstract | INTRODUCTION: Lung cancer is the most prevalent cancer type affecting both sexes in Norway. Most cases discovered without screening are not eligible for curative treatment. Low-dose computed tomography (LDCT) can detect cases which are still treatable curatively. The Norwegian payer’s decision to implement screening also depends on cost-effectiveness. Data on the economic feasibility of screening is still lacking in Norway, especially in a high risk population for whom clinical trials are underway. The research questions examine whether the Norwegian payer would decide for implementing lung cancer screening from a cost-effectiveness perspective, and whether uncertainty would change its decision. METHODS: A Markov cohort model was constructed to project the lifetime costs and health outcomes of lung cancer with or without LDCT screening in a cohort of 60 years old heavy smokers (≥35 pack-years). The screening strategy mimicked the ongoing 4-IN-THE-LUNG-RUN trial (biennial screening for all, annual for those who tested positive at baseline). The natural history of the disease without screening was calibrated to epidemiological data, albeit sample size was less than ideal. Up-to-date Norwegian sources were used to quantify costs and survival after diagnosis. Screening characteristics were derived from international clinical trials. Sensitivity analyses was carried out, as well as scenario analysis including different target populations. RESULTS: The base-case (comparing no screening to the 4-IN-THE-LUNG-RUN screening strategy) resulted in an incremental cost-effectiveness ratio (ICER) of 704,284 NOK per quality-adjusted life year (QALY). In contrast, considering unadjusted life years, screening was projected to have an ICER of 232,006 NOK. At a willingness-to-pay threshold of 385,000 NOK per QALY, the model projects a 3.1% probability that LDCT screening is cost-effective. Of all tested scenarios, the lowest ICER with the same intervention and comparator (414,176 NOK per QALY) was achieved in a population where the calibration target had the biggest sample size (60 year-olds with 20 pack-years). CONCLUSION: From a cost-effectiveness perspective, the Norwegian payer is unlikely to consider implementing lung cancer screening. As the results are not robust to the quality of calibration targets, the decision needs to be re-evaluated as better data becomes available. | eng |