| Abstract: [Objectives] To evaluate the cost-utility, benefits, and harms of absolute risk-based low-dose computed tomography (LDCT) screening in the non-somkers of Henan Province, and to determine the optimal risk threshold or appropriate individuals eligible for screening. [Methods] Individual’s absolute 1-year risk of developing lung cancer was assessed based on the established risk-prediction model, and then was used to divide the total non-smokers into high-, medium-high-, medium-low-, and low- risk groups, with the risk thresholds of ≥0.2725%、0.1100%~<0.2725%、0.0124%~<0.1100% and < 0.0124%, respectively. A decision tree Markov model was developed to evaluate the health economics of annual LDCT screening for individuals with different risk thresholds. The primary outcome was incremental cost utility (ICUR), i.e., the incremental cost per quality-adjusted life year (QALY) gained. Secondary outcomes included: the number of lung cancer deaths averted, life-years gained from screening, and the number of overdiagnosed lung cancer cases, radiation-related lung cancer cases, and false-positive findings. [Results] Under the willingness to pay threshold of 3-time the gross domestic product (GDP) of China in 2021 (242,928 CNY), annual LDCT screening for individuals with a 1-year risk threshold of 0.2725% was the only cost-utility strategy compared with no screening, with an ICUR of 141,807 CNY per QALY. As the risk threshold increased, average number screens per lung cancer death averted and average number screens per life-year gained progressively decreased. In addition, as the risk threshold increased, LDCT screening yielded fewer cases of overdiagnosed lung cancer, fewer cases of radiation-related lung cancer, and fewer false-positive findings. [Conclusions] Annual LDCT screening for non-smokers with a 1-year risk threshold of 0.2725% could improve the cost utility and balance the benefits and harms of LDCT screening. |
