• Steven D Criss, Pianpian Cao, Mehrad Bastani, Kevin Ten Haaf, Yufan Chen, Deirdre F Sheehan, Erik F Blom, Iakovos Toumazis, Jihyoun Jeon, Harry J de Koning, Sylvia K Plevritis, Rafael Meza, and Chung Yin Kong.
• Massachusetts General Hospital, Boston, Massachusetts (S.D.C., Y.C.).
• Ann. Intern. Med. 2019 Dec 3; 171 (11): 796-804.

BackgroundRecommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST).ObjectiveTo compare the cost-effectiveness of different stopping ages for lung cancer screening.DesignBy using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT).Data SourcesThe NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses' Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator.Target PopulationCurrent, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort.Time Horizon45 years.PerspectiveHealth care sector.InterventionAnnual LDCT according to NLST, CMS, and USPSTF criteria.Outcome MeasuresIncremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).Results Of Base Case AnalysisThe 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates.Results Of Sensitivity AnalysisProbabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%).LimitationScenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data.ConclusionAll 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective.Primary Funding SourceCISNET (Cancer Intervention and Surveillance Modeling Network) Lung Group, National Cancer Institute.

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