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To the Editor: Dr Mahadevia and colleagues¹ concluded that, even if efficacy of screening with helical CT were ultimately to be established by ongoing trials, it is unlikely to be highly cost-effective without significant reductions in costs as well as in rates of mortality, adherence, and overdiagnosis. The authors incorporated an exceedingly large number of factors in their analytic model, including estimates and sensitivity tests of adherence rates to screening protocol; length, lead time, and overdiagnosis biases; quality of life; and informal caregiver costs. Yet, given the current state of knowledge, it is precisely this all-encompassing approach that is worrisome, and one that might lead prematurely to the conclusion that lung cancer screening with CT is cost-ineffective.

In an analysis with similar aims,² we concluded that CT screening for lung cancer might well be more cost-effective than it first appears. However, our analysis incorporated fewer variables, mostly because we felt . . . [Full Text of this Article]

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