Abstract

Objectives: Lung cancer is the deadliest cancer worldwide, with most cases being identified in a late stage where curative treatment is no longer an option. Tobacco use is the primary cause of lung cancer. Screening smokers has been shown to be a cost-effective intervention in multiple countries. This article aims to evaluate the cost-effectiveness of lung cancer screening in the Kingdom of Saudi Arabia.

Methods: A cost-effectiveness model consisting of a decision tree, determining the number of cases and the stage at diagnosis, along with a Markov model that projects the lifetime disease pathway. The model was developed to compare scenarios with and without lung cancer screening. The number of cases was determined using the overdiagnosis rate from the NELSON trial and current incidence rates, adjusted for differences between the trial and Saudi clinical practice. Six scenarios were analyzed, varying by age ranges and geotargeting, and assessed across multiple thresholds.

Results: In each scenario, screening results in additional cases identified, (quality-adjusted) life-years gained, and higher costs. The incremental cost-effectiveness ratios ranged from $31,222 when screening people aged 60–74 in the Eastern region to $110,042 when screening people aged 50–74 nationwide.

Conclusion: Depending on the willingness-to-pay threshold, lung cancer screening could be cost-effective nationwide for individuals aged 55–74, or only in the Eastern region for those aged 60–74, or in neither scenario. Implementing a pilot program in Saudi Arabia would provide additional information to determine the cost-effectiveness of implementing lung cancer screening.

 

Keywords

lung cancer, screening, LDCT, cost-effectiveness, Saudi Arabia