Preliminary Decision by CMS to Cover Lung Cancer Screening

“The Centers for Medicare & Medicaid Services (CMS) has made a preliminary decision to cover lung cancer screening with low-dose computed tomography (LDCT) for eligible patients.

“The decision was welcomed by a number of professional societies, including the American Thoracic Society, the Lung Cancer Alliance, and the American College of Chest Physicians.

“In April, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) voted against recommending national Medicare coverage for annual screening for lung cancer with low-dose CT in high-risk individuals. Although the MEDCAC vote isn’t binding, their ruling ignited intense pushback from healthcare professionals, patient advocates, and professional associations. More than 40 medical societies have urged CMS to provide coverage for older adults. Even politicians have entered the fray, with members of the US House and Senate asking CMS to reimburse for screening.

” ‘LDCT has been shown to reduce mortality when used to screen individuals who are at high risk for developing lung cancer because of their age and smoking history,’ Charles Powell, MD, chief of pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City and chair of the American Thoracic Society’s thoracic oncology assembly, said in a statement.

” ‘While there is some risk of overdiagnosis, it is outweighed by the mortality benefit that has been demonstrated with screening targeted groups of high-risk patients,’ he said.”


Lung Cancer Screening Found Cost-Effective for Medicare

“Low-dose computed tomography (LDCT) is a low-cost and cost-effective strategy for screening Medicare beneficiaries for lung cancer, according to a study published in the August issue of American Health & Drug Benefits.

“Bruce S. Pyenson, from Milliman Inc. in New York City, and colleagues estimated the cost and cost-effectiveness (cost per life-year saved) of LDCT lung cancer screening in the Medicare population at high risk for lung cancer. Medicare & Medicaid Services (CMS) beneficiary files (2012) were used to establish Medicare costs, enrollment, and demographics. CMS and U.S. Census Bureau projections were used for forecasts to 2014.

“The researchers found that approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately three years. The average annual cost of LDCT lung cancer screening is estimated to be $241 per Medicare person screened. For Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years, assuming a 50 percent screening rate, LDCT screening for lung cancer is low cost, at approximately $1 per member per month. This screening demonstrates highly cost-effectiveness, at <$19,000 per life-year saved.

” ‘If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014,’ the authors write. ‘LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring.’ “


Less Costly to Screen for and Treat Early-Stage Lung than to Treat Late-Stage Lung Cancer

“The average cost to screen high-risk individuals for developing lung cancer with low-dose computed tomography (LDCT) plus the average cost of curative intent treatment, like surgery, is lower than the average cost to treat advanced stage lung cancer, which quite rarely results in a cure.

“The National Lung Cancer Screening Trial (NLST) has previously shown that LDCT screening of people at high-risk for lung cancer reduces lung cancer mortality by 20%, thus many organizations including the United States Preventative Services Task Force (USPSTF) have recommend LDCT screening for these individuals. It is thought that if lung cancer is detected at an early stage with screening that it can be cured and the consequences of this are a significant reduction in lung cancer mortality, as the 5-year survival rate for early-stage disease is 54%, and a reduction in the need for expensive and toxic treatments for advanced late-stage lung cancer, which seldom results in a cure as reflected by a 5-year survival rate of 4%. However, in the US 8.6 million people meet the high-risk criteria, which could equate to a significant screening cost.

“The Pan-Canadian Early Detection Study prospectively examined the costs for the resources used to screen annually, treat (if necessary), and follow for 2 years 2059 participants who had a 2% or greater risk of developing lung over 3 years as determined by a Web-based lung cancer risk prediction tool.”


No Long-Term Anxiety or Distress Associated with Low-Dose Computed Tomography Screening

“Examination and review of several studies that evaluated patient-centered outcomes for individuals undergoing low-dose computed tomography (LDCT) screening for lung cancer found that screening does not appear to significantly influence overall health-related quality of life or result in long-term changes in anxiety or distress, but that positive results in the short-term, do increase distress levels.”


Improved Diagnostic Performance of Low-Dose Computed Tomography Screening

“Investigators of the COSMOS (Continuous Observation of SMOking Subjects) study show good compliance and patient survival outcomes using a 5-year low-dose computed tomography (LDCT) screening protocol in individuals at high-risk of developing lung cancer. This protocol had fewer patients requiring further diagnostic follow-up compared to other studies, including the National Lung Cancer Screening Trial (NLST), with a minimal number of incorrect diagnoses.”