AbstractBackgroundLung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain.AimTo describe the first direct medical costs associated with lung cancer screening in Australia.MethodsSingle‐centre prospective screening cohort. Healthy volunteers (age 60–74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack‐years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values.ResultsA total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow‐up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non‐surgical median survival post‐diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false‐positive scan work‐up; AU$96 340 true‐positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow‐up post‐treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non‐surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care).ConclusionsAdvanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.