Blog | Tuesday, April 10, 2012

QD: News Every Day--Actuaries find spiral CT screening among smokers is cost-effective

Annual lung cancer screening with low-dose spiral computed tomography among current and former smokers would reduce lung cancer and be cost-effective according to an actuarial model.

Screening would cost about $1 per insured member per month, and the cost per life-year saved would be below $19,000, an amount that compares favorably with screening for cervical, breast and colorectal cancers, the authors noted.

The study appeared in Health Affairs.

The actuarial model was designed to estimate the cost and cost-benefit of lung cancer screening for smokers and former smokers ages 50 to 64, with at least 30 pack-years of smoking each. This group is estimated to consist of about 18 million people, or about 30% of people in this age range.

Population details were derived from 2010 Census Bureau projections. The authors used published annual protocols for both low-dose spiral CT lung cancer screening and follow-up visits during the year following the screening, until a diagnosis of either cancer or no cancer was made within the year following the screening. All patients received an initial screening and annual repeat screenings. They then applied the 2011 Medicare fee schedule, since it is widely used by commercial payers as a benchmark.

The authors estimated the average annual cost of lung cancer screening to be $247 per person screened. The price of repeat screening plus follow-up is about one-third lower than that of initial screening because this follow-up is less intense.

Assuming that half of people ages 50 to 64 with 30 or more pack-years of smoking were screened, the insurer cost spread across the commercial population would be $0.76 per member per month, with no cost sharing, less than breast, colorectal, or cervical cancer screening.

Lung cancer screening costs less than other cancer screens because much of the evaluation of suspicious nodules occurs without a biopsy, by checking for changes in nodule volume between screenings, the authors noted. Also, the target population for lung cancer screening is high-risk smokers and former smokers ages 50 to 64, a smaller target than other cancer populations. It also has a lower cost per life-year saved than other screenings because symptomatically detected lung cancer is frequently more quickly fatal, which translates into a higher number of life-years saved.

The authors concluded, "Our findings suggest that commercial insurers should consider lung cancer screening with low-dose spiral CT to be of substantial value in high-risk populations and should consider providing coverage that includes such screening."