Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: The israeli experience

Amir Shmueli*, Shifra Fraifeld, Tamar Peretz, Orit Gutfeld, Maya Gips, Jacob Sosna, Dorith Shaham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Objective Reduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel. Methods A decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases - lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated. Results Base-case incremental cost per QALY gained was $1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than $10,000 with probability 0.937 and is lower than $20,000 with probability 0.978. Conclusions Our analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.

Original languageAmerican English
Pages (from-to)922-931
Number of pages10
JournalValue in Health
Issue number6
StatePublished - Sep 2013
Externally publishedYes

Bibliographical note

Funding Information:
Source of financial support: The study was supported by grants from the Israeli Cancer Society and the Joint Fund of the Faculty of Medicine of the Hebrew University-Hadassah School of Medicine.


  • cost per QALY Israel low-dose computed tomography lung cancer


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