Cost-effectiveness and budget impact of lung cancer screening in time of immunotherapy

BACKGROUND: Lung cancer screening in high-risk populations with low-dose computed tomography (LDCT) reduces lung cancer mortality by detecting cancer at early stage. Immunotherapy improves survival in these patients. This study evaluates the cost-effectiveness and budget impact of LDCT screening extending immunotherapy to early-stage patients. METHODS: A micro-simulation model Simulation Model on Radiation Risk and cancer Screening (SiMRiSc, validated against NELSON results) was used to a Dutch heavy smokers cohort. Average cost-effectiveness ratio (ACER), lung cancer mortality reduction, and budget impact of biennial screening for heavy smokers aged 55-74 (adapted from the UK strategy) were evaluated in context of immunotherapy, compared with no-screening. A cost-effectiveness threshold was set at 60 k€ per life year gained (LYG). RESULTS: Compared with no-screening, limiting immunotherapy to advanced-stage patients, screening resulted in ACERs of 4.7 k€/LYG for males and 6.6 k€/LYG for females, reducing lung cancer mortality by 18.1 % and 17.1 %, respectively. Extending immunotherapy to all stages increased ACERs to 5.2 k€/LYG for males and 7.1 k€/LYG for females, with lung cancer mortality reduction of 21.1 % and 20.1 %, respectively. Budget impact analysis shows screening saved 35-52 million€ when immunotherapy restricted to advanced-stage, and 24-39 million€ for all stages immunotherapy over three-screening rounds compared with no-screening, primarily due to a 53 % reduction for advanced-stage cases. CONCLUSION: Lung cancer screening in high-risk population remains cost-effective when immunotherapy is offered to all stages. By shifting diagnoses from advanced to early stages, screening yielding substantial savings. These findings support LDCT screening implementation even in healthcare systems broadly using immunotherapy.