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Cost-effectiveness of Screening for Lung Cancer—Reply
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In Reply: The strikingly different arguments posed by Dr Reich, Dr Petty, and Dr Chirikos and colleagues exemplify the debate occurring in lung cancer screening with helical CT.
Reich states that our model has an underlying bias favoring screening and its cost-effectiveness. We did give screening the benefit of the doubt. For example, in our simulation, the screened group experienced both absolute and relative differences in stage distribution. The screened group had fewer advanced-stage cancers with a corresponding increase in the numbers of localized-stage cancers than the nonscreened group. We then incrementally increased the numbers of localized-stage cancers by the degree of length and overdiagnosis biases, which are most prominent in the first year of screening.
We did assume that individuals diagnosed with cancer by length and overdiagnosis phenomena would have a long-term prognosis similar to that of individuals without lung cancer. However, we did model operative mortality with decrements . . . [Full Text of this Article]
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