Results of an actuarial analysis suggest that offering lung cancer screening with low-dose spiral computed tomography (CT) as a commercial insurance benefit to individuals who are 50 to 64 years old and have a smoking history of 30 pack-years or more could save lives at relatively low cost.
Cost-benefit Calculations
“Assuming current commercial reimbursement rates for treatment, we found that screening would cost about $1 per insured member per month in 2012 dollars,” according to a report of the analysis in Health Affairs.1 Not only should commercial insurers consider lung cancer screening of high-risk individuals to be high-value coverage and provide it as a benefit to high risk people, but “payers and patients should demand screening from high-quality, low-cost providers, thus helping set an example of efficient system innovation,” the authors wrote.
The authors noted that low-dose spiral CT has improved greatly in the past 20 years and “reduced the need for invasive procedures to determine the presence or absence of cancer.” Tobacco cessation counseling was included in the screening cost calculation. “Previous studies have found that low-dose spiral CT screening can provide a ‘teachable moment’ that is associated with increased success in tobacco cessation efforts,” the authors stated. They estimated that the cost per life-year saved with low-dose spiral CT scanning for high-risk individual “would be below $19,000, an amount that compares favorably with screening for cervical, breast, and colorectal cancers.”
The study model estimated the cost and cost-benefit of lung cancer screening for smokers and former smokers between the ages of 50 and 64 with a smoking history of 30 pack-years. The estimated total is 18 million people or about 30% of the U.S. population aged 50 to 64.
“The baseline screening scenario would lead to more than 130,000 additional lung cancer survivors in 2012,” the authors stated. “This increase is attributable to screening. It does not include the more than 64,000 ‘lead-time people’ who would be living with lung cancer and would have first become symptomatic within 2 years of the screening. Some of these 64,000 people would avoid death from lung cancer in years beyond 2012 because of screening, but we did not include them in our 2012 figure of survivors, because—with or without screening—they would have been alive in 2012.”
The authors noted that their analysis was completed before the results of the National Lung Screening Trial were published and that their “estimates of the proportion of early-stage lung cancer that would be detected by screening and of mortality reduction as a result of screening are more optimistic than the results of the trial. We attribute these differences partly to the design of the trial, which required that it be terminated as soon as significant mortality differences of greater than 20% appeared, and partly to our assumptions based on the use of current, improved imaging and screening workup approaches that emerged after the trial began.” ■
Reference
1. Pyenson BS, Sander MS, Jiang Y, et al: Health Affairs 31:770-779, 2012.
