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The February 2012 article by Goulart et al titled, “Lung Cancer Screening With Low-Dose Computed Tomography: Costs, National Expenditures, and Cost-Effectiveness,” (J Natl Compr Canc Netw 2012, doi: 10.6004/jnccn.2012.0023 ) was published with an

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Bernardo H. L. Goulart, Mark E. Bensink, David G. Mummy and Scott D. Ramsey

A recent randomized trial showed that low-dose CT (LDCT) screening reduces lung cancer mortality. Health care providers need an assessment of the national budget impact and cost-effectiveness of LDCT screening before this intervention is adopted in practice. Using data from the 2009 National Health Interview Survey, CMS, and the National Lung Screening Trial (NLST), the authors performed an economic analysis of LDCT screening that includes a budget impact model, an estimate of additional costs per lung cancer death avoided attributed to screening, and a literature search of cost-effectiveness analyses of LDCT screening. They conducted a one-way sensitivity analysis, reporting expenditures in 2011 U.S. dollars, and took the health care payer and patient perspectives. LDCT screening will add $1.3 to $2.0 billion in annual national health care expenditures for screening uptake rates of 50% to 75%, respectively. However, LDCT screening will avoid up to 8100 premature lung cancer deaths at a 75% screening rate. The prevalence of smokers who qualify for screening, screening uptake rates, and cost of LDCT scan were the most influential parameters on health care expenditures. The additional cost of screening to avoid one lung cancer death is $240,000. Previous cost-effectiveness analyses have not conclusively shown that LDCT is cost-effective. LDCT screening may add substantially to the national health care expenditures. Although LDCT screening can avoid more than 8000 lung cancer deaths per year, a cost-effectiveness analysis of the NLST will be critical to determine the value of this intervention and to guide decisions about its adoption.

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Douglas E. Wood, Ella A. Kazerooni, Scott L. Baum, George A. Eapen, David S. Ettinger, Lifang Hou, David M. Jackman, Donald Klippenstein, Rohit Kumar, Rudy P. Lackner, Lorriana E. Leard, Inga T. Lennes, Ann N.C. Leung, Samir S. Makani, Pierre P. Massion, Peter Mazzone, Robert E. Merritt, Bryan F. Meyers, David E. Midthun, Sudhakar Pipavath, Christie Pratt, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Peter B. Sachs, Matthew B. Schabath, Mark L. Schiebler, Betty C. Tong, William D. Travis, Benjamin Wei, Stephen C. Yang, Kristina M. Gregory and Miranda Hughes

screening will lead to earlier detection of lung cancer—before patients have symptoms and when treatment is more likely to be effective—and will decrease mortality. 11 Data support using low-dose computed tomography (LDCT) of the chest to screen select

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Douglas E. Wood, Ella Kazerooni, Scott L. Baum, Mark T. Dransfield, George A. Eapen, David S. Ettinger, Lifang Hou, David M. Jackman, Donald Klippenstein, Rohit Kumar, Rudy P. Lackner, Lorriana E. Leard, Ann N.C. Leung, Samir S. Makani, Pierre P. Massion, Bryan F. Meyers, Gregory A. Otterson, Kimberly Peairs, Sudhakar Pipavath, Christie Pratt-Pozo, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Peter B. Sachs, Matthew B. Schabath, Lecia V. Sequist, Betty C. Tong, William D. Travis, Stephen C. Yang, Kristina M. Gregory and Miranda Hughes

5-year survival rate is only 16.8%. 5 , 6 Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) to screen individuals at high risk for lung cancer. 7 – 11 Chest

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Peter B. Bach

Because lung cancer frequently presents in an advanced stage when it is incurable, there has been a sustained search for an early diagnosis approach that could detect lung cancer when curable, while having few secondary consequences. Decades of research have evaluated various approaches to lung screening, including routine chest radiograph, sputum cytology, and, most recently, computed tomography (CT) scanning. No study has suggested that any of these approaches will identify life-threatening lung cancers at an earlier disease stage and allow alteration of their natural history. Therefore, no recommending body or professional society recommends using any of these approaches to screen for lung cancer. This general recommendation could change if randomized trials examining CT screening suggest that its benefits outweigh its harms.

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Bernardo H. L. Goulart and Scott D. Ramsey

The Authors' Reply: We appreciate the insightful comments from Dr. Detterbeck and colleagues, which certainly enrich a timely discussion about the economic implications of lung cancer screening with low-dose computed tomography (LDCT). 1 To

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Frank Detterbeck, Lynn Tanoue and Amanda Reid

To the Editor: In the February 2012 issue of JNCCN , Goulart et al 1 performed a careful cost-effectiveness analysis of low-dose computed tomography (LDCT) screening for lung cancer. They relied predominantly on data from the National Lung

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Jennifer A. Lewis, Heidi Chen, Kathryn E. Weaver, Lucy B. Spalluto, Kim L. Sandler, Leora Horn, Robert S. Dittus, Pierre P. Massion, Christianne L. Roumie and Hilary A. Tindle

screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups . J Thorac Cardiovasc Surg 2012 ; 144 : 33 – 38 . 10.1016/j.jtcvs.2012.05.060 7. Bach PB , Mirkin JN , Oliver TK , . Benefits and harms of CT

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William D. MD Unger Michael MD, FCCP Yang Stephen C. MD 2 2012 10 10 2 2 240 240 265 265 0100240 10.6004/jnccn.2012.0022 Lung Cancer Screening With Low-Dose Computed Tomography: Costs, National Expenditures, and Cost

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be effective.” The new NCCN Guidelines for Lung Cancer Screening primarily refer to Non-Small Cell Lung Cancer, the most common type of lung cancer, and recommend helical low-dose computed tomography (LDCT) screening for select patients at high risk