Although the effectiveness of lung cancer screening by low-dose computed tomography (LDCT) could be shown in China, there could be variation in the evidence concerning the economic impact. Our study explores the cost-effectiveness of lung cancer screening and optimizes the best definition of a high-risk population. A Markov model consisting of the natural history and post-diagnosis states was constructed to estimate the costs and quality-adjusted life years (QALYs) of LDCT screening compared with no screening. A total of 36 distinct risk factor-based screening strategies were assessed by incorporating starting ages of 40, 45, 50, 55, 60 and 65 years, stopping ages of 69, 74 and 79 years as well as smoking eligibility criteria. Screening data came from community-based mass screening with LDCT for lung cancer in Guangzhou. Compared with no screening, all screening scenarios led to incremental costs and QALYs. When the willingness-to-pay (WTP) threshold was USD37,653, three times the gross domestic product (GDP) per capita in China, six of nine strategies on the efficiency frontier may be cost-effective. Annual screening between 55 and 79 years of age for those who smoked more than 20 pack-years, which yielded an incremental cost-effectiveness ratio (ICER) of USD35,000.00 per QALY gained, was considered optimal. In sensitivity analyses, the result was stable in most cases. The trends of the results are roughly the same in scenario analyses. According to the WTP threshold of different regions, the optimal screening strategies were annual screening for those who smoked more than 20 pack-years, between 50 and 79 years of age in Zhejiang province, 55–79 years in Guangdong province and 65–74 years in Yunnan province. However, annual screening was unlikely to be cost-effective in Heilongjiang province under our modelling assumptions, indicating that tailored screening policies should be made regionally according to the local epidemiological and economic situation.
尽管低剂量计算机断层扫描（LDCT）在中国已被证实对肺癌筛查有效，但其经济影响的证据可能存在差异。本研究探讨了肺癌筛查的成本效益，并优化了高危人群的最佳定义。通过构建包含自然病史和诊断后状态的马尔可夫模型，评估了LDCT筛查与不筛查相比的成本和质量调整生命年（QALYs）。研究共评估了36种基于不同风险因素的筛查策略，涵盖起始年龄（40、45、50、55、60和65岁）、终止年龄（69、74和79岁）以及吸烟资格标准。筛查数据来源于广州市基于社区的LDCT肺癌大规模筛查。与不筛查相比，所有筛查方案均增加了成本和QALYs。当支付意愿（WTP）阈值为37,653美元（中国人均国内生产总值的三倍）时，效率前沿上的九种策略中有六种可能具有成本效益。其中，对吸烟超过20包年的55至79岁人群进行年度筛查被认为是最优策略，其增量成本效益比（ICER）为每获得一个QALY需35,000.00美元。敏感性分析显示，结果在大多数情况下保持稳定。情景分析的结果趋势大致相同。根据不同地区的支付意愿阈值，最优筛查策略为：浙江省对吸烟超过20包年的50至79岁人群进行年度筛查，广东省为55至79岁，云南省为65至74岁。然而，根据我们的模型假设，黑龙江省的年度筛查可能不具备成本效益，这表明应根据当地的流行病学和经济状况制定区域化的筛查政策。
肿瘤(癌症)患者之家