Recent evidence on the effectiveness of low-dose computed tomography (LDCT) lung cancer screening, such as the National Lung Cancer Screening Study (NLST) or the Dutch-Belgian Randomised Lung Cancer Screening Study (NELSON), seems to confirm a possible relative reduction in lung cancer mortality (although not in all-cause mortality) from LDCT-screening. Since then, a considerable body of new evidence also emerged on the cost-effectiveness of LDCT-screening for lung cancer. In this context, the present systematic review aimed to update the evidence on the cost-effectiveness, cost-utility and budget impact of LDCT lung cancer screening in adult persons with increased risk of lung cancer. Special emphasis was placed on the methods of health economic evaluations.

A systematic literature search in six databases and an extensive hand search was conducted. General study characteristics with a focus on health economic methods (e.g. cost factors), as well as the results of the included health economic studies were extracted and summarised in tabular form.

In total, 25 health economic studies met the predefined inclusion criteria, although only 13 of the 25 studies –that were not yet included in previous systematic reviews– were included for qualitative synthesis. The key methods of the analysed studies included the definition of the economic perspective, the time horizon and discount rates, as well as specific methods for cost estimation, such as the consideration of different cost factors (e.g. screening participation rate, LDCT sensitivity and specificity, incidental findings). Furthermore, three main cost components have been identified for an LDCT-screening programme: screening costs, treatment costs, and costs for supportive and palliative care. In general, the evidence did not provide clear results on the cost-effectiveness of LDCT-screening in individuals at risk for lung cancer.

Lung cancer screening is a cost-intensive intervention, and introducing it on a population level generally depends both on its cost-effectiveness and likely budget impact. Given the considerable variation in the study methodology and cost-effectiveness results of the analysed studies, it is currently not possible to make contentions about the potential cost-effectiveness of LDCT lung cancer screening. For this reason, an economic evaluation and a simultaneous assessment of the national willingness to pay are recommended for the Austrian context.