Screening for Lymphangioleiomyomatosis by High-Resolution Computed Tomography in Young, Nonsmoking Women Presenting with Spontaneous Pneumothorax Is Cost-Effective

(LAM) who present with a sentinel spontaneous pneumothorax (SPTX) will experience an average of 2.5 additional pneumothora-ces. The diagnosis of LAM is typically delayed until after the second pneumothorax. Objectives: We hypothesized that targeted screening of an LAM-enriched population of nonsmokingwomen between the ages of 25 and 54 years, who present with a sentinel pneumothorax indicated by high-resolution computed tomography (HRCT), will facilitate early identification, definitive therapy, and improved quality of life for patients with LAM. Methods: We constructed a Markov state-transition model to assess the cost-effectiveness of screening. Rates of SPTX and prevalence of LAM in populations stratified by age, sex, and smoking status were derived from the literature. Costs of testing and treatment were extracted from 2007Medicare data. We compared a strategy based on HRCT screening followed by pleurodesis for patients with LAM, versus no HRCT screening. Measurements and Main Results: The prevalence of LAM in nonsmok-ing women, between the ages of 25 and 54 years, with SPTX is estimated at 5 % on the basis of the available literature. In our base case analysis, screening for LAM by HRCT is the most cost-effective strategy, with a marginal cost–effectiveness ratio of $32,980 per quality-adjusted life-yeargained.Sensitivityanalysis showedthatHRCT screening remains cost-effective for groups inwhich the prevalence of LAM in the population subset screened is greater than 2.5%. Conclusions: Screening for LAM by HRCT in nonsmoking women age 25–54 thatpresentwithSPTX iscost-effective.Physiciansareadvisedto screen for LAM by HRCT in this population