An estimated 40,000 people in California suffered from lung cancer in 2014, including nearly 2,000 Medi-Cal recipients. Although the increased coverage by Center for Medicaid Studies and Medicare Services (CMS) and the Affordable Care Act (ACA) has resulted in greater access to preventive health care, coordinated strategies are needed to prevent lung cancer. Policymakers, LHDs and medical purchasers need accurate information on the costs of lung cancer in their region to identify cost-effective strategies. Thus, the purpose of this three-paper dissertation was to estimate the cost and lost QALYs of lung cancer in California counties, provide LHDs with a guide to conduct ROIs for newly, proposed interventions as well as help them understand the differences between cost studies, provide information concerning how to monetize outcomes, and finally, attempt to estimate the ROI of implementing a lung cancer screening program. An estimated 1.2 billion dollars is currently being spent on lung cancer in California, including $33.3 million on the Medi-Cal population. The burden of lung cancer also includes 259,889 lost QALYs from the overall population and 36,169 lost QALYs from the Medi-Cal population. ROI analysis is a great method for deciding whether or not to invest in new program because outcomes can be monetized. ROI estimates suggest a cost savings with early detection of lung cancer and an even higher return when outcomes such as QALYs lost are monetized and considered in the ROI analysis. In conclusion, LHDs and medical purchasers are not the decision makers when it comes to implementing new programs such as lung cancer screening; rather the process is a political one. This study demonstrates a method of estimating ROI for investing in a new lung cancer screening program to provide policymakers with estimates of the scope of the problems by region and county.

Keywords: Costs, lung cancer, QALYs, ROI