在2021年的肺癌筛查建议更新中，美国预防服务工作组（USPSTF）评估了基于个人肺癌风险的选择策略（风险模型策略），强调需要进一步研究风险模型筛查的益处和风险。为了评估和比较基于风险模型的肺癌筛查策略与USPSTF建议的成本效益，并探索最佳风险阈值。比较建模分析。国家肺部筛查试验；监测，流行病学和终末结果计划；美国吸烟历史生成器。1960年美国出生队列。45岁。美国医疗保健部门。在基于风险模型的策略中，每年进行低剂量计算机断层扫描，从50或55岁开始筛查，到80岁停止筛查，使用PLCOm2012模型在6年风险阈值为0.5％至2.2％之间。增量成本效益比（ICER）和成本效益效率前沿，连接具有给定成本的最高健康效益的策略。基于风险模型的筛查策略比USPSTF建议更具成本效益性，且仅由成本效益效率前沿组成。在效率前沿上的策略中，具有6年风险阈值为1.2％或更高的策略具有低于10万美元每质量调整后生命年（QALY）的ICER成本效益性。具体而言，1.2％风险阈值的策略ICER为94659美元（模型范围为72639-156774美元），相对于USPSTF建议而言，成本更低，产生更多的QALY，同时具有类似的筛查覆盖率（每人筛查率为21.7％，而USPSTF的为22.6％）。在不同的建模假设下，基于风险模型的策略均显著比2021年的USPSTF建议成本效益更高。风险模型仅限于年龄，性别和与吸烟有关的风险因素预测因素。基于风险模型的筛查比USPSTF建议更具成本效益性，因此值得进一步考虑。国家癌症研究所（NCI）。

In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening.To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds.Comparative modeling analysis.National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator.1960 U.S. birth cohort.45 years.U.S. health care sector.Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model.Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost.Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%).Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions.Risk models were restricted to age, sex, and smoking-related risk predictors.Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration.National Cancer Institute (NCI).