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Nationwide Adoption of LDCT Screening Will Detect More Early-Stage Lung Cancer, but at Substantial Economic Cost

June 2014, Vol 5, No 5

Chicago, IL—The US Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography (LDCT) lung cancer screening for patients at high risk. What would it mean in terms of cost to society if those recommendations were implemented in the Medicare population?

A study using budget impact modeling projected that an LDCT lung cancer screening program that adheres to the USPSTF recommendations in a Medicare population would identify approximately 54,900 more cases of lung cancer over a 5-year period, mainly early-stage disease, but at a substantial economic cost, said lead investigator Joshua A. Roth, PhD, MHA, a postdoctoral fellow at Fred Hutchinson Cancer Research Center, Seattle, WA.

Dr Roth presented these results at the 2014 American Society of Clinical Oncology meeting, noting that the 5-year cost would be approximately $9 billion in Medicare expenditures.

Medicare is expected to make a decision on LDCT lung cancer screening coverage in November 2014, and this decision is likely to rely heavily on the USPSTF recommendations, said Dr Roth. “The take-home message from this presentation is that Medicare should plan for increased expenditures if the USPSTF recommendation is adopted.”

The investigators used a budget impact model to arrive at these calculations. They selected the Medicare population, because it has the highest rates of lung cancer and a large proportion of members who fit into the high-risk category for annual screening, which includes age 55 to 80 years, a 30-pack-year smoking history, current smoker, or quit smoking within the past 15 years, Dr Roth explained.

The USPSTF recommendations are based largely on the findings from the National Lung Screening Trial (NLST), which demonstrated a 20% reduction in lung cancer deaths with LDCT lung cancer screening compared with x-ray screening.

The current model assumed that over a 5-year period, 20% more high-risk patients will be offered screening annually. The investigators examined 3 scenarios:

  • Expected use based on experience with mammography (50% of patients offered screening undergo screening annually)
  • A low-use scenario (only 25% of patients offered screening follow through with it)
  • A high-use scenario (75% of patients offered annual screening take advantage of it).

The investigators compared LDCT screening with no screening, inputting NLST data along with data from the Surveillance, Epidemiology, and End Results Program and from the peer-reviewed literature.

The expected-use scenario would yield 11.2 million more LDCT scans and would result in 54,900 additional lung cancers detected over 5 years versus no screening. Early diagnoses would rise from 15% to 33%. The total 5-year expenditure for LDCT imaging, diagnostic workup, and lung cancer care would be $9.3 billion. Dr Roth said that this would increase the Medicare premium per member by $3 monthly.

The low-use scenario would cost $5.9 billion, whereas the high-use scenario would cost $12.7 billion (with monthly premium increases per Medicare member of $1.90 and $4.10, respectively).

Dr Roth said that the major proportion of the Medicare expenditure would be for the CT scans.

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