Cost-effectiveness of low-dose CT lung cancer screening among individuals that have ever smoked in Norway: A model-based analysis using NELSON trial criteria and outcomes.

Clinical trials have shown that low-dose computed tomography (LDCT) screening reduces lung cancer mortality among selected groups of ever-smokers. Nordic countries have yet to implement lung cancer screening programs in part due to limited evidence on the associated health and economic consequences. This study evaluated the cost-effectiveness of LDCT screening compared with no screening for Norwegian individuals aged 50-74 years who ever smoked, using the Dutch-Belgian NELSON screening-eligibility criteria and trial outcomes. In addition, we evaluated the potential need and value of additional research to improve decision-making about LDCT screening implementation. We developed a probabilistic simulation model reflecting the Dutch-Belgian NELSON trial outcomes and Norwegian epidemiological, cost, and health-related quality-of-life data to evaluate long-term (discounted) health and economic consequences from an extended healthcare perspective. Model outputs included sex-stratified clinical and economic outcomes. Cost-effectiveness was summarized using incremental cost-effectiveness ratios (ICERs). Compared with no screening, NELSON-like LDCT screening provided an additional 0.043 quality-adjusted life-years (QALYs) per screened man for an additional $1286, yielding an ICER of $30,672 per QALY gained. For women, screening yielded greater health benefits and therefore a lower ICER (i.e., $22,249 per QALY gained), though there was greater uncertainty around health benefits. Additional analyses indicated potential value in collecting further evidence on screening-related outcomes to reduce decision uncertainty, particularly for women. Given Norwegian benchmarks for good value and achieving similar mortality benefits to the NELSON trial, LDCT lung cancer screening for individuals who ever smoked under "NELSON-like" criteria may be considered cost-effective for both men and women in Norway.