Cost of a population-based programme of chest x-ray screening for lung cancer.

Background. After the implementation of a population-
based programme of chest x-ray (CXR) screening on
smokers in Varese, Italy, lung cancer (LC) mortality was
significantly reduced. Analysis of the incremental costs
due to this type of screening programme is needed to evaluate its economic impact on the healthcare system.
Methods. In July 1997 a population-based cohort,
consisting of all high-risk smokers (n=5,815) identified
among 60,000 adult residents from the Varese province,
was invited to a LC screening programme (an annual
CXR for five years) in a general practice setting, and was
observed through 2006. Invitees received National Health
Service (NHS) usual care, with the addition of CXRs in
screening participants. At the end of observation, among
the 245 LCs diagnosed in the entire screening-invited cohort
the observed LC deaths were 38 fewer than expected.
To estimate the incremental direct cost due to screening
in the invited cohort for the period July 1997-2006, we
compared the direct cost of screening administration,
CXR screens and LC management in the invited cohort
and in the uninvited and unscreened controls in NHS
usual care setting.
Results. Over the 9.5 years, the total incremental direct
healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from € 607,440 to € 618,370 (in euros as of 2012), equating to between € 15,985- € 16,273 per patient out of the 38 LC deaths averted.
Conclusions. In a general practice setting, the incremental
cost for a CXR screening programme targeted at
all high-risk smokers in a population of 60,000 adults was
estimated to be about €65,000 per annum, approx. €16,000
for each LC death averted.