Supplemental Table 1. Inputs – Utility Weights/Quality of Life.

Non-lung cancer / Ages / Females / Males / Source
20-29 / 0.915 / 0.939 / 1
30-39 / 0.900 / 0.910
40-49 / 0.868 / 0.881
50-59 / 0.838 / 0.854
60-69 / 0.824 / 0.841
70-79 / 0.786 / 0.822
80-89 / 0.747 / 0.752
NSCLC states / Description / Base case / Sensitivity analyis / Sources
Post-lobectomy or chemo with CR, no recurrence* / 0.79* / 0.88* / 2-4
Post-chemo +/- RT with PR or SD, no recurrence / 0.79 / 0.69
Post-chemo + RT with CR, no recurrence / 0.79 / 0.79
Any treatment, after recurrence / 0.62 / 0.52
SCLC states
Post-lobectomy, no recurrence* / 0.79* / 0.88*
Post-chemo +/- RT with SD, no recurrence / 0.79 / 0.31
Post-chemo +/- RT with PR, no recurrence / 0.79 / 0.95
Post-chemo +/- RT with CR, no recurrence / 0.79 / 0.99
Post-lobectomy, after recurrence / 0.31 / 0.95
Post-chemo +/- RT with SD,after recurrence / 0.31 / 0.31
Post-chemo +/- RT with PR, after recurrence / 0.99 / 0.31
Post-chemo +RT with CR, after recurrence / 0.83 / 0.31
Post-chemo with CR, after recurrence / 0.99 / 0.31
*Recovery / Months with post-lobectomy utility before return to non-lung cancer / 3 / 1, 6, 12, 24, never / 5-7

Abbreviations: CR, complete response; PR, partial response; SD, stable disease; RT, radiotherapy.

Supplemental Table 2. Inputs – CT, Program, Participant, and Treatment Characteristics.

Helical CT characteristics / Description / Base Case Value / Source / Value in Sensitivity Analysis
Diameter (mm) of peripheral* nodules / Sensitivity
0 / 0.00 / 8 / 1.0 (perfect for all nodules)
1 / 0.63
4 / 0.77
8 / 1.00
Specificity / 1.0 (perfect) / See text
Cost / $283 / CPT 71250§ / $188
Screen program characteristics / Follow-up protocol / Nodules <4mm ignored / As in NLST / Serial CT (see text)
Eligibility / Current and former smokers with minimum 20 pack-years (PY) / Current and former heavy smokers (minimum PY = 40); Current and former smokers who quit within the last 10 years (minimum PY = 20); Current heavy smokers
(minimum PY = 40)
Cessation intervention effectiveness / n/a / 4, 8, 16, 30% annual
Cessation intervention cost / n/a / $300, $1800
Effectiveness / See notes below.
Participant characteristics / Adherence / 100% (perfect) / 70%
Background cessation rate (no intervention) / 3% / 9, 10 / 8% (0.1 PY), 3% (36 PY), 0.45% (100 PY)¦ 11
Treatment characteristics / Cost / See Table 3 / SEER-Medicare 1992-2003
Operative mortality
Lobectomy / 4.0% / 12 / 3.0%
VATS / 0.5% / 13 / 0.2%
Mediastinoscopy / 0.3% / 14 / 0.1%

Notes: Mortality reduction is not a model input; screening effectiveness is predicted by the model as a non-linear function of characteristics of CT examinations, screening program, participants, and treatment effectiveness.

* CT assumed to have lower sensitivity for central nodules (75% of that for peripheral nodules) to account for obstruction by aorta, etc.; lung cancer cell types vary in proportion central/peripheral.

§ thoracic computed tomography, no contrast media. Base case estimates from 2006 Physician’s Fee Schedule; sensitivity analysis estimates from the 2006 Hospital Outpatient Prospective Payment System (HOPPS).

¦ selected cessation rates from logistic assuming OR of 1.03 per pack-year, centered at 3% cessation for smokers with 36 PY.

References

1. Hanmer J, Lawrence W, Anderson J, Kaplan RM, Fryback DG. Report of nationally representative values for the non-institutionalized US adult population for seven health related quality of life scores. Med Decis Making 2006;26(4):391-400.

2. Earle C, Chapman R, Baker C, Bell C, Stone P, Sandberg E, et al. Systematic overview of cost-utility assessments in oncology. Journal of Clinical Oncology 2000;18(18):3302-17.

3. Handy JR, Jr., Asaph JW, Skokan L, Reed CE, Koh S, Brooks G, et al. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122(1):21-30.

4. van den Hout WB, Kramer GWPM, Noordijk EM, Leer J-WH. Cost-utility analysis of short- versus long-course palliative radiotherapy in patients with non-small-cell lung cancer. J. Natl. Cancer Inst. 2006;98(24):1786-94.

5. Yabroff KR, McNeel TS, Waldron WR, Davis WW, Brown ML, Clauser S, et al. Health limitations and quality of life associated with cancer and other chronic diseases by phase of care. Medical Care 2007;45(7):629-37.

6. Cannon J, Win T. Long-term quality of life after lung resection. Thorac Surg Clin 2008;18(1):81-91.

7. Balduyck B, Hendriks J, Lauwers P, Van Schil P. Quality of life after lung cancer surgery: a prospective pilot study comparing bronchial sleeve lobectomy with pneumonectomy. J Thorac Oncol 2008;3(6):604-8.

8. McMahon PM, Kong CY, Gazelle GS. Model profiler of the MGH-ITA Lung Cancer Policy Model. Available from URL: [accessed May 6, 2010.

9. Centers for Disease Control. Smoking Cessation During Previous Year Among Adults -- United States, 1990 and 1991. Morbidity and Mortality Weekly Report 1993;42(26):504-07.

10. The Commit Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. American Journal of Public Health 1995;85:193-200.

11. Ashraf H, Tonnesen P, Pedersen JH, Dirksen A, Thorsen H, Dossing M. Smoking habits were unaffected by CT screening at 1-year fol-low-up in the Danish Lung Cancer Screening Trial (DLCST). Thorax 2008;64(5):388-92.

12. Bach P, Cramer L, Schrag D, Downey R, Gelfand S, Begg C. The influence of hospital volume on survival after resection for lung cancer. New England Journal of Medicine 2001;345:181-88.

13. Detterbeck FC, Rivera MP. Clinical presentation and diagnosis. In: Detterbeck FC, editor. Diagnosis and Treatment of Lung Cancer, Philadelphia, PA: W.B. Saunders Company, 2001.

14. Esnaola N, Lazarides S, Mentzer S, Kuntz K. Outcomes and cost-effectiveness of alternative staging strategies for non-small-cell lung cancer. Journal of Clinical Oncology 2002;20(1):263-73.

1