CT Screening for Lung Cancer Cost-Effective

Using CT scans to screen older smokers who are at risk for lung cancer appears to be as cost-effective as several other common screening studies, researchers found.

In an actuarial model analysis, using low-dose spiral CT to screen smokers and former heavy smokers, ages 50 to 64, had a cost per life-year saved similar to that for colorectal cancer screening, at about $19,000, Bruce Pyenson, of the healthcare consulting firm Milliman in New York, and colleagues reported in the April issue of Health Affairs.

That cost was cheaper than both breast cancer and cervical cancer screening, they found.

The results suggest that “commercial insurers should consider lung cancer screening of high-risk individuals to be high-value coverage and provide it as a benefit to people who are at least 50-years-old and have a smoking history of thirty pack-years or more,” the authors wrote.

Most private insurers don’t cover lung cancer screening, even in high-risk patients, because the data on its cost-efficacy have been limited, they explained.

However, the National Lung Screening Trial (NLST) found last year that low-dose spiral CT was associated with a 20% reduction in cancer death compared with x-ray screening.

So to test whether such screening could also be cost-effective, Peyson and colleagues created a model of spiral CT screening among smokers and long-term former smokers with at least 30 pack-years of smoking each. This study population had private health insurance and were not covered by any kind of public health insurance.

Scientists have studied several types of screening tests for lung cancer.

Several tests have been studied to see if they can detect lung cancer early with the goal of decreasing deaths from lung cancer. There is little evidence that chest X-rays or sputum cytology can prevent people from dying from lung cancer. Screening for lung cancer with chest X-rays was once promoted by some experts, but researchers found out that people who were screened did not have a lower death rate than people who were not screened. Promising results have been reported recently that people who had low-dose helical CT scans did have a lower chance of dying from lung cancer than people who had chest X-rays.

Screening also has its downside. Screening tests may find spots (abnormalities) in the lungs. These spots could be cancer or not cancer (benign). More tests may be needed to find out if the spot is a cancer. These tests might include removing a small piece of lung tissue for more testing (biopsy). This means that some people might have a surgical procedure even though they don’t have cancer (false positive). These procedures have risks associated with them and can cause anxiety and cost money.

Experts do not know if the benefits of screening (early detection) outweigh the potential harms (false positives), especially for people who do not smoke. For these reasons, experts do not currently recommend for or against lung cancer screening.

For this model, they used published, annual protocols for low-dose spiral CT lung cancer screening and follow-up visits during the subsequent year, until one of two diagnoses - cancer or no cancer - was made within the year following the screening. All patients received an initial screening and annual repeat screenings.

They assumed 18 million people would fall into that high-risk category, and about half would undergo CT-based lung cancer screening if it were covered - an uptake rate comparable to colorectal cancer screening, they said.

Why is cancer screening important?
Cancer is the leading cause of death in the United States of people under 85, and the second leading cause of death, after heart disease, for people over 85.  Cancer is one of the most expensive diseases to treat, especially when detected at late stage.

Screening increases the chance of being diagnosed at early when cancer can be more successfully treated and even cured. Early stage diagnosis is associated with longer survival rates, as can be seen below with three cancers that have screening tests: Mammography for breast cancer; PSA testing for prostate cancer; and colonoscopy for colon cancer.

They estimated that lung cancer screening would cost $247 per patient tested annually, assuming that three-fourths of the screenings were repeat procedures. When spread over the total commercially insured population, the total cost would be just $0.76 per insured member per month with no cost sharing, they reported.

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