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We assessed benefits and costs of introducing a bronchial gene\u2010expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete\u2010event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (<jats:italic>i<\/jats:italic>) location\u2010based strategy\u2014integrated the BGC to the bronchoscopy indication; (<jats:italic>ii<\/jats:italic>) simplified strategy\u2014extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality\u2010adjusted\u2010life\u2010years (QALYs), costs and incremental cost\u2010effectiveness ratios. Compared to the standard practice, the location\u2010based strategy (<jats:italic>i<\/jats:italic>) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (<jats:italic>ii<\/jats:italic>) reduced absolute rate of invasive procedures by 10% and improved quality\u2010adjusted life expectancy, producing an incremental cost\u2010effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location\u2010based is cost\u2010saving if the price of classifier declines.<\/jats:p>","DOI":"10.1002\/ijc.32333","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T10:21:51Z","timestamp":1555064511000},"page":"781-790","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A bronchial\u2010airway gene\u2010expression classifier to improve the diagnosis of lung cancer: Clinical outcomes and cost\u2010effectiveness analysis"],"prefix":"10.1002","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5263-3964","authenticated-orcid":false,"given":"Elvira","family":"D'Andrea","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niteesh Kumar","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Raby","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital, Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald Lawrence","family":"Weinhouse","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Brigham and Women's Hospital  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Najafzadeh","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital and Harvard Medical School  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,5,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21387"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1740774516638345"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1158\/1940-6207.CAPR-14-0364"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5521"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2351"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2353"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-2067"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504601"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.02.636"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2017.04.030"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2017.01.012"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-016-0217-1"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.7.914"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-9-200305060-00009"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.11.018"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060476"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2005.02.010"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200119080-00007"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-6-84"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06290495"},{"key":"e_1_2_7_23_1","unstructured":"Centers for Medicare & Medicaid Services (CMS).Medicare Physician Fee Schedule (MPFS). 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