Lung Cancer Screening in a Population from Northeast Italy Exposed to Both Asbestos and Smoking: A Cost-Effectiveness Analysis

Our plain-English summary of Lung Cancer Screening in a Population from Northeast Italy Exposed to Both Asbestos and Smoking: A Cost-Effectiveness Analysis, by R. Cosulich, C. Thomas, F. Barbiero, et al (Journal of Clinical Medicine, 2026).

The study

• Authors: R. Cosulich, C. Thomas, F. Barbiero, D. Gillespie, E. Bidoli, M.A. Cova, S. Lovadina, A. Guglielmi, L. Dal Maso, B. Alessandrini, F. Larese Filon, F. Barbone, E. Baratella
• Journal: Journal of Clinical Medicine
• Published: 2026;15(8)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Past workplace exposure to asbestos in combination with tobacco smoking has increased the risk of lung cancer for some residents in an area within the Friuli Venezia Giulia region, Northeast Italy. In light of studies showing that lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality, local stakeholders and decision-makers decided to assess the potential benefits, harms and cost-effectiveness of a single round of LCS with LDCT versus standard care among people aged 55 to 80 who were formerly exposed to asbestos and with at least 10 pack-years of smoking. Methods: An economic model was developed using a decision tree connected to a Markov cohort model. The primary outcome was the incremental cost per additional quality-adjusted life year (QALY). Other outcomes included the number of life years saved, the number of deaths averted and overdiagnosis. Results: Per 10,000 people screened, the intervention led to 395 additional QALYs (95% credible interval: 129 to 831) and incremental total costs of EUR 1,086,345 (95% credible interval: -852,607 to 2,155,826). The incremental cost per QALY gained was EUR 2750. There was a probability of cost-effectiveness of 99.5% relative to a threshold of EUR 25,000. Conclusions: The model estimated that the intervention was cost-effective. The model's simplifications and limitations should be considered when interpreting the findings in relation to policy-making decisions. Further research could include the costs and benefits of incidental findings and could assess the cost-effectiveness of repeated rounds of screening for the same population.

In plain English

This study was a computer cost-effectiveness model, not a trial in which people were screened. The authors modelled a single round of lung cancer screening with low-dose CT and compared it with standard care ("passive surveillance"), in which people were advised to attend check-ups with X-rays every two or three years. The modelled group was people aged 55 to 80 in the ASUGI area of Friuli Venezia Giulia, Northeast Italy, who were formerly exposed to asbestos and had at least 10 pack-years of smoking. Per 10,000 people screened, the model estimated 39 lung cancer deaths averted (95% credible interval 13 to 79), 481 life years saved (166 to 985) and 395 quality-adjusted life years (QALYs) gained (129 to 831). The extra cost was EUR 2750 per QALY gained. Screening had a 99.5% probability of being cost-effective at EUR 25,000 per QALY. Per 10,000 screened, the model also estimated 5 overdiagnosed cancers and 14 surgeries on benign nodules. The authors concluded that screening was cost-effective. They cautioned that some inputs came from other populations and that subgroup results need caution.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Health economic model (cost-effectiveness analysis): a decision tree linked to a Markov cohort model with a lifetime horizon; no people were screened in this study
• Who was studied: A modelled cohort aged 55 to 80, formerly exposed to asbestos, currently or formerly smoking with at least 10 pack-years, living in the ASUGI area (Trieste and Monfalcone, Friuli Venezia Giulia, Northeast Italy); split into sex and age groups using proportions from the regional registry of people formerly exposed to asbestos
• Exposure: Past workplace asbestos exposure, mostly before 1985, in the Trieste and Monfalcone areas, combined with tobacco smoking (at least 10 pack-years); fiber types not specified. The intervention modelled was a one-off low-dose CT screen versus standard care (passive surveillance)
• Main results:
  • Per 10,000 people screened (versus standard care): 39 lung cancer deaths averted (95% CI 13 to 79), 481 life years saved (95% CI 166 to 985), 395 QALYs gained (95% CI 129 to 831)
  • Across all subgroups, the incremental cost per additional QALY was EUR 2750
  • Probability of cost-effectiveness at a threshold of EUR 25,000 per QALY was 99.5%
  • Total costs increased by EUR 109 per screening participant, with a 9.2% probability that screening would save money
  • Overdiagnosis: per 10,000 people screened, 5 lung cancers would be found that would never have presented clinically without screening
  • Per 10,000 people screened, 14 surgeries on false-positive benign nodules
  • Screening was cost-effective within each sex and age subgroup at EUR 25,000 per QALY
  • In all scenario analyses screening remained cost-effective; lowering screen-detectable prevalence raised the cost per QALY considerably
• The authors' conclusion: The authors concluded that a single round of low-dose CT lung cancer screening was cost-effective, relative to thresholds of EUR 25,000 or higher, for people formerly exposed to asbestos with at least 10 pack-years, aged 55 to 80, living in the ASUGI area. They added that the model's limitations should be considered for policy-making.
• Limitations the authors state:
  • Some parameters came from populations outside the ASUGI area, outside Italy, or without dual exposure to smoking and asbestos
  • Diagnostic and treatment costs covered only five years, shorter than the model's lifetime horizon
  • Quality-of-life values (utilities) were adjusted for smoking but not for asbestos exposure
  • Screen-detectable prevalence was assumed equal for men and women; subgroup results should be interpreted with particular caution
  • Costs and benefits of incidental findings were not included
  • Repeated screening rounds were not analysed

Topics

Medical terms in this study, explained in our Lexicon: Low-Dose CT Screening, Lung Cancer.

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