Editorial Cost-effectiveness of computed tomography lung cancer

While the assiduity of Castleberry et al in compiling and analysing this huge data assemblage is commendable, regrettably, their conclusion that population CT screening is more cost-effective than symptomatic tumour identification at improving lung cancer (LC) outcomes is based on three demonstrably flawed premises: (1) Survival is a valid metric of LC screening efficacy. Efficacy denotes a reduction in mortality. Although it is counter-intuitive, increased LC survival has not proven to be a valid surrogate or proxy for increased life expectancy. Using SEER data, Welch et al (2000) reported that in 1950–1954 vs 1989–1995, 5-year LC survival more than doubled (from 6 to 14%), while the increase in incidence (249%) was exceeded by the increase in mortality (259%). Similarly, 5-year LC survival in the intervention cohorts of the randomised