PURPOSE: Hodgkin lymphoma (HL) survivors face an increased risk of 
treatment-related lung cancer. Screening with low-dose computed tomography 
(LDCT) may allow detection of early stage, resectable cancers. We developed a 
Markov decision-analytic and cost-effectiveness model to estimate the merits of 
annual LDCT screening among HL survivors.
METHODS AND MATERIALS: Population databases and HL-specific literature informed 
key model parameters, including lung cancer rates and stage distribution, 
cause-specific survival estimates, and utilities. Relative risks accounted for 
radiation therapy (RT) technique, smoking status (>10 pack-years or current 
smokers vs not), age at HL diagnosis, time from HL treatment, and excess 
radiation from LDCTs. LDCT assumptions, including expected stage-shift, 
false-positive rates, and likely additional workup were derived from the 
National Lung Screening Trial and preliminary results from an internal phase 2 
protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% 
discount rate and a willingness-to-pay (WTP) threshold of $50,000 per 
quality-adjusted life year (QALY).
RESULTS: Annual LDCT screening was cost effective for all smokers. A male smoker 
treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 
12 years post-HL, with a life expectancy benefit of 2.1 months and an 
incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a 
QALY benefit in some cases, but the incremental cost was not below the WTP 
threshold for any patient subsets. As age at HL diagnosis increased, earlier 
initiation of screening improved outcomes. Sensitivity analyses revealed that 
the model was most sensitive to the lung cancer incidence and mortality rates 
and expected stage-shift from screening.
CONCLUSIONS: HL survivors are an important high-risk population that may benefit 
from screening, especially those treated in the past with large radiation fields 
including mantle or involved-field RT. Screening may be cost effective for all 
smokers but possibly not for nonsmokers despite a small life expectancy benefit.