OBJECTIVES Lung cancer detection by low-dose computed tomographic screening reduces mortality. However, it is essential to assess cost-effectiveness. We present a cost-effectiveness analysis of screening in Italians at high risk of lung cancer, from the point of view of the Italian tax-payer. MATERIALS AND METHODS We used a decision model to estimate the cost-effectiveness of annual screening for 5 years in smokers (≥30 pack-years) of 55-79 years. Patients diagnosed in the COSMOS study were the screening arm; patients diagnosed and treated for lung cancer in the Lombardy Region, Italy, constituted the usual care arm. Treatment costs were extracted from our hospital database. Lung cancer survival in screened patients was adjusted for 2-year lead-time bias. Life-years and quality-adjusted life-years were estimated by stage at diagnosis, from which incremental cost-effectiveness ratios per life-year and quality-adjusted life-year gained were estimated. RESULTS Base-case incremental cost-effectiveness ratios were 3297 and 2944 euro per quality-adjusted life-year and life-year gained, respectively. Deterministic sensitivity analysis indicated that these values were particularly sensitive to lung cancer prevalence, screening sensitivity and specificity, screening cost, and treatment costs for stage I and IV disease. From the probabilistic sensitivity analysis incremental cost-effectiveness ratios had a 98 % probability of being <25,000 euro (widely-accepted threshold) and a 55 % probability of being <5000 euro. CONCLUSIONS Low-dose computed tomographic screening is associated with an incremental cost of 2944 euro per life-year gained in high risk population, implying that screening can be introduced in Italy at contained cost, saving the lives of many lung cancer patients.

中文翻译：

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在意大利进行肺癌筛查的有利的增量成本效益比。

目的通过低剂量计算机断层扫描筛查肺癌可以降低死亡率。但是，评估成本效益至关重要。从意大利纳税人的角度出发，我们提出了对具有高肺癌风险的意大利人进行筛查的成本效益分析。材料和方法我们使用决策模型来估计55-79岁的吸烟者（≥30包年）中5年年度筛查的成本效益。在COSMOS研究中诊断出的患者为筛查臂。在意大利的伦巴第大区，经肺癌诊断和治疗的患者是通常的护理部门。从我们的医院数据库中提取治疗费用。筛查患者的肺癌生存率根据2年的前置时间偏差进行了调整。在诊断时按阶段估算了生命年和经过质量调整的生命年，从中可以估算出每个生命年和经过质量调整的生命年的成本效益比。结果基本情况下，每质量调整生命年和获得生命年的增量成本效益比分别为3297和2944欧元。确定性敏感性分析表明，这些值对肺癌的患病率，筛查敏感性和特异性，筛查成本以及I期和IV期疾病的治疗成本特别敏感。根据概率敏感性分析，成本效益比的增量有98％的可能性小于25,000欧元（被广泛接受的阈值），而55％的可能性小于5000欧元。结论低剂量计算机体层摄影筛查与高危人群每生命年增加2944欧元的费用相关，