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  2. npj primary care respiratory medicine
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Cost-effectiveness of lung cancer screening: insights from risk stratification, guidelines, and emerging technologies—a systematic review
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  • Review
  • Open access
  • Published: 20 January 2026

Cost-effectiveness of lung cancer screening: insights from risk stratification, guidelines, and emerging technologies—a systematic review

  • Zijuan Fan1 na1,
  • Manqi Zheng1 na1,
  • Ziyun Guan1,
  • Hanting Liu1,
  • Pengyue Guo1,
  • Yang Zhu1,
  • Bo Zhang1,
  • Luyao Hu1,
  • Xianqi Zhao1,
  • Tiantian Fu1,
  • Mengting Liu1,
  • Xinran Jiang1,
  • Ningjun Ren1,
  • Chunli Zhang1,
  • Wenxi Wang2,
  • Chun Hao1,3 &
  • …
  • Jinghua Li4 

npj Primary Care Respiratory Medicine , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Epidemiology
  • Health care economics
  • Health policy
  • Public health

Abstract

Lung cancer is the leading cause of cancer-related mortality worldwide, with most patients diagnosed at advanced stages. Early detection through screening can significantly reduce mortality, making cost-effectiveness evidence crucial for guiding policy decisions. This systematic review aimed to evaluate the cost-effectiveness of lung cancer screening across various modalities, populations, and settings. A comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Library was conducted for studies up to March 18, 2025, adhering to PRISMA guidelines. A total of 79 studies from 21 countries were included, with model-based analyses prevalent and 89.9% rated as high quality. Low-dose computed tomography (LDCT) emerged as the primary screening modality, although evidence on artificial intelligence (AI) and biomarkers is limited. Fourteen studies comparing LDCT with no screening showed incremental cost-effectiveness ratios (ICERs) ranging from $8376 to $200,921 per quality-adjusted life-year (QALY) gained. Notably, 90.3% of LDCT strategies were cost-effective by national thresholds, particularly in older adults and high-risk groups. Biennial screening often proved more cost-effective than annual in many scenarios. Overall, LDCT screening demonstrated favorable cost-effectiveness, necessitating further evaluation for emerging technologies in underserved regions.

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Data Availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

We would like to acknowledge the State Key Laboratory of Respiratory Disease for its valuable advice.

Funding

This research was funded by Start-up Research Grant of the University of Macau (SRG2025-00031-FHS). The funder played no role in study design, data collection, analysis and interpretation of data, or the writing of this manuscript.

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Author notes

  1. These authors contributed equally: Zijuan Fan, Manqi Zheng.

Authors and Affiliations

  1. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Zijuan Fan, Manqi Zheng, Ziyun Guan, Hanting Liu, Pengyue Guo, Yang Zhu, Bo Zhang, Luyao Hu, Xianqi Zhao, Tiantian Fu, Mengting Liu, Xinran Jiang, Ningjun Ren, Chunli Zhang & Chun Hao

  2. The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China

    Wenxi Wang

  3. Sun Yat‑Sen Global Health Institute, Institute of State Governance, Institute of International and Regional Studies, Sun Yat-sen University, Guangzhou, China

    Chun Hao

  4. Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macao SAR, China

    Jinghua Li

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Contributions

ZJF and MQZ contributed equally as co-first authors. ZJF and MQZ conceptualized the study and developed the protocol. ZJF, ZYG and MQZ designed the search strategy and conducted the literature search. HTL, PYG, YZ, BZ, LYH and XQZ performed data screen and extraction. TTF, MTL, XRJ, NJR and CLZ assessed data quality. ZJF and MQZ conducted data analysis. WXW, CH and JHL provided expert supervision during data extraction and analysis. ZJF and MQZ drafted the initial manuscript. HTL, PYG, YZ, BZ, LYH, WXW, CH and JHL critically revised the manuscript for important intellectual content and supervised data interpretation.

Corresponding authors

Correspondence to Wenxi Wang, Chun Hao or Jinghua Li.

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Competing interests

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Fan, Z., Zheng, M., Guan, Z. et al. Cost-effectiveness of lung cancer screening: insights from risk stratification, guidelines, and emerging technologies—a systematic review. npj Prim. Care Respir. Med. (2026). https://doi.org/10.1038/s41533-026-00482-w

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  • Received: 21 June 2025

  • Accepted: 12 January 2026

  • Published: 20 January 2026

  • DOI: https://doi.org/10.1038/s41533-026-00482-w

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