Study Projects Nationwide Low-Dose CT Screening Will Identify More—and Earlier-Stage—Lung Cancers, but Comes With Substantial Medicare Costs
A new model projects 5-year outcomes of implementing the recent U.S. Preventive Services Task Force (USPSTF) recommendations for annual low-dose computed tomography (CT) lung cancer screening in a high-risk Medicare population. The model estimates that gradual implementation of the screening program would result in roughly 54,900 more lung cancer cases detected over a 5-year period, a large majority of which would be early-stage disease. While similar lung cancer screening models have been developed previously, this is the first study looking specifically at the Medicare population, which has the highest lung cancer incidence and a large proportion of members who qualify for screening. The findings were presented today at a presscast in advance of the 2014 ASCO Annual Meeting (Abstract 6501).
“If we can diagnose lung cancers at an earlier stage, patients can be treated far more effectively and survival prognosis is much better,” said lead study author Joshua A. Roth, PhD, MHA, a postdoctoral research fellow at Fred Hutchinson Cancer Research Center in Seattle. “However, the key to the success of this screening program is ensuring that those who are at high risk actually undergo screening and subsequently receive appropriate treatment.”
Study Details
The USPSTF recommendations are largely based on the findings from the National Lung Cancer Screening Trial, which demonstrated a 20% reduction of lung cancer deaths with low-dose CT screening compared to x-ray screening. Annual low-dose CT screening is recommended for persons age 55 to 80 years with a 30 pack-year smoking history who currently smoke or quit within the past 15 years.
The model assumes that, over a 5-year period, an additional 20% of high-risk patients are offered screening each year. Because the rate of screening use has the greatest influence on clinical, resource, and budget outcomes, the investigators considered three different screening use scenarios for implementation: an expected-use scenario based on historic experience with mammography (50% of patients who are offered screening undergo screening every year), a low-use scenario (25% of patients who are offered screening undergo screening every year), and a high-use scenario (75% of patients who are offered screening undergo screening every year).
Results
The high screening use scenario would detect the most lung cancer cases at an early stage, but may not be feasible given the staff, technical, financial, and patient education resources required.
In the expected screening use scenario, the screening would yield 11.2 million more low-dose CT scans and result in 54,900 more lung cancers detected over 5 years, compared to no screening. It is estimated that this program would increase the proportion of early-stage diagnoses from 15% to 33%. The total 5-year Medicare expenditure for low-dose CT imaging, diagnostic workup, and cancer care would be $9.3 billion, which amounts to a $3.00 per month premium increase per Medicare member.
In the low- and high-screening use scenarios, the total 5-year Medicare expenditure would be $5.9 billion and $12.7 billion, or a $1.90 and $4.10 monthly premium increase per Medicare member, respectively.
Researchers are planning future analyses that will assess and consider available resources and demand for additional scanners and technologists. These analyses will help health-care systems adequately prepare for the implementation of the USPSTF screening policy.
“Tobacco use continues to contribute far too much to the nation’s cancer burden,” said ASCO President Clifford A. Hudis, MD, FACP. “While low-dose CT screening offers a long-awaited early lung cancer detection strategy, as doctors we must do everything possible to provide patients with the encouragement and resources they need to stop smoking, and prevent the next generation of young adults from starting.”
This research was funded by Genentech. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
