Table 5.
Results of Sensitivity Analyses.
| Scenario | Cost per QALY |
|---|---|
| U.S. $ | |
| Base case* | 81,000 |
| Inclusion of non–lung-cancer deaths | 54,000 |
| Relative risk of screening with radiography vs. no screening (1.0) | |
| 0.8 | 40,000 |
| 0.94† | 62,000 |
| 1.1 | 171,000 |
| No. of future excess cases (0)‡ | |
| 29 | 66,000 |
| 58 | 55,000 |
| Survival for stage IA non–small-cell lung cancer (intermediate) | |
| Low | 67,000 |
| High | 108,000 |
| Cost of screening with low-dose CT ($285) | |
| 100 | 56,000 |
| 500 | 110,000 |
| Multiplier for no. of follow-up screenings with low-dose CT (1) | |
| 0.5 | 78,000 |
| 5 | 110,000 |
| Multiplier for cost of surgery (1 = $22,000) | |
| 0.5 | 73,000 |
| 3 | 114,000 |
| Surgical mortality (1.2%) | |
| 0.0% | 79,000 |
| 8.0% | 96,000 |
| Future health care costs (0 after CT; 0 after no screening) | |
| $171,018 after CT screening | 120,000 |
| $170,248 after no screening | |
| Reduction in quality of life after positive screen (0) | |
| 0.05 | 116,000 |
| Reduction in quality of life after diagnosis of stage IA lung cancer (0.03) | |
| 0.07 | 101,000 |
| Cost of managing potentially significant incidental finding ($500) | |
| 0 | 78,000 |
| $2,500 | 96,000 |
| Radiation-induced lung-cancer deaths per lung-cancer death prevented (0.046) | |
| 0 | 79,000 |
| 0.092 | 83,000 |
*
The base case reflects several assumptions made to reduce the complexity of the analysis and minimize the use of variables for which there are no reliable estimates. The base-case value for each variable is given in parentheses.
†
The point estimate is for the subgroup of the Prostate, Lung, Colorectal, and Ovarian Cancer-Screening Trial that was eligible for the National Lung Screening Trial.16
‡
Future excess cases represent the additional number of lung cancers diagnosed after the trial in the radiography group as compared with the CT group.