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Programme design requires specifying eligibility criteria, screening interval, and the optimal age range. We estimate benefits and harms of competing strategies, integrating NELSON results, smoking cessation interventions, contemporary treatment costs, and the management of feasible CT capacity. 1080 strategies are evaluated using the MISCAN\u2010Lung microsimulation model, calibrated to NELSON and NLST data. 1945\u20131979 Dutch cohorts are simulated using a representative smoking history generator. For each strategy, the (cost\u2010)effectiveness is evaluated, as well as CT requirements and the incremental benefit of a smoking cessation intervention (pharmacotherapy). Lung cancer screening was found to be cost\u2010effective overall. Risk\u2010based recruitment (PLCOm2012) is more efficient than pack\u2010year\u2010based criteria. Annual screening ages 55\u201375 from &gt;\u20091.5% lung cancer risk is cost\u2010efficient (ICER\u2009&lt;\u2009\u20ac20\u2009k), and would cost \u20ac12,201 per quality\u2010adjusted life\u2010year (QALY) relative to no screening (or \u20ac19,713 compared to less intensive screening). Population\u2010wide, lung cancer mortality would be reduced by 10.8% (1072 cases\/year) at full uptake, or by 6.2% at 50% uptake. For the first three years, at 50% uptake of screening, the strategy requires a 16.1% increase of national CT volume. Nearly half of CT costs are offset by reductions in terminal care expenditures. Integrated smoking cessation is cost\u2010effective at \u20ac10,043\/QALY (relative to screening without integrated cessation), yielding 32% additional life\u2010years gained. Lung cancer screening is increasingly cost\u2010effective and may be critically considered for implementation, including integrated smoking cessation. We find annual screening ages 55\u201375 for those &gt;\u20091.5% (PLCOm) risk to be within a \u20ac20\u2009k willingness\u2010to\u2010pay and feasible CT requirements.<\/jats:p>","DOI":"10.1002\/ijc.70655","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:18:54Z","timestamp":1785392334000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Optimal Lung Cancer Ct Screening Strategy: A Cost\u2010Effectiveness Study Incorporating Nelson Evidence, Evolving Cost of Treatment and Smoking Cessation Interventions"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1451-0557","authenticated-orcid":false,"given":"Koen","family":"de Nijs","sequence":"first","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5006-6938","authenticated-orcid":false,"given":"Kevin","family":"ten Haaf","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Moldovanu","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juul","family":"Hubert","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"van den Bosch","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlijn","family":"van der Aalst","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-3646","authenticated-orcid":false,"given":"Harry J.","family":"de Koning","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC\u2014University Medical Center Rotterdam  Rotterdam CE the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Netherlands Cancer Registry \u201cSurvival by year from diagnosis Relative Surival Lung\/bronchus \u201d(2023) NCR Data https:\/\/nkr\u2010cijfers.iknl.nl\/viewer\/relatieve\u2010overleving\u2010per\u2010jaren\u2010na\u2010diagnose?language=en_GB&viewerId=3501968d\u2010ba43\u20104019\u20108162\u201025e4d31859c7."},{"key":"e_1_2_12_3_1","unstructured":"International Agency for Research on Cancer World Health Organisation \u201cGlobocan\u2014Absolute Cancer Incidence in Europe both sexes \u201dhttps:\/\/gco.iarc.fr\/today\/en\/dataviz\/pie?mode=cancer&key=total&populations=908&types=0&sort_by=value1&multiple_populations=1&multiple_cancers=1&group_populations=1&sexes=0."},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2363","article-title":"Advances in Systemic Therapy for Non\u2010Small Cell Lung Cancer","volume":"375","author":"Miller M.","year":"2021","journal-title":"BMJ"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.annonc.2023.01.010","article-title":"European Cancer Mortality Predictions for the Year 2023 With Focus on Lung Cancer","volume":"34","author":"Malvezzi M.","year":"2023","journal-title":"Annals of Oncology"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1056\/NEJMoa1916623","article-title":"The Effect of Advances in Lung\u2010Cancer Treatment on Population Mortality","volume":"383","author":"Howlader N.","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1056\/NEJMoa1102873","article-title":"Reduced Lung\u2010Cancer Mortality With Low\u2010Dose Computed Tomographic Screening","volume":"365","author":"National Lung Screening Trial Research T","year":"2011","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced Lung\u2010Cancer Mortality With Volume CT Screening in a Randomized Trial","volume":"382","author":"Koning H. 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