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.”

Commentary: CMS Should Use Caution When Implementing Lung Cancer Screening

“A strategy that limits CMS [Centers for Medicare and Medicaid Services] coverage of lung cancer screening to certified and comprehensive centers may be preferable to widespread coverage due to the potential harms associated with screening and a lack of data specific to the Medicare population, according to a commentary published today in Annals of Internal Medicine.

“ ‘It is essential that low-dose CT screening programs have the proper infrastructure in place to ensure standardized interpretation and reporting of CT results, a protocolized evaluation process for screen-detected nodules, and a coordinator to ensure patients receive evaluation in a timely and appropriate fashion,’ Renda Soylemez Wiener, MD, MPH, assistant professor of medicine in The Pulmonary Center of the Boston University School of Medicine, told HemOnc Today. ‘Through a process of certification of screening programs, CMS can ensure that Medicare beneficiaries undergoing low-dose CT screening have it done in a way that maximizes benefits and minimizes harms from lung cancer screening.’ “

More than 130 Lawmakers Urge Coverage for Lung Cancer Test that Could Cost Medicare Billions

“More than 130 lawmakers are urging the Obama administration to expand coverage for a lung-cancer test under Medicare that could cost the program billons, calling the screening important for vulnerable seniors.

“In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer.”

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.”

The Ups and Downs of Lung Cancer Screening with Low-Dose CT

“As a form of cancer that kills 90% of those who develop it, lung cancer is a particularly fearsome adversary to the field of oncology. However, because half of patients with lung cancer have advanced disease at the time of diagnosis, early detection offers hope for reduced mortality.

“To this end, several organizations — including the American Cancer Society (ACS), the National Comprehensive Cancer Network, the American Lung Association (ALA) and the US Preventive Services Task Force (USPSTF) — have updated their lung cancer screening guidelines to suggest screenings with low-dose CT.”

Lung Cancer Screening Would Cost Medicare Billions

“Implementation of a national lung cancer screening program using low-dose computed tomography (LDCT) will identify almost 55,000 additional lung cancer cases over 5 years, but will add more than $9 billion to Medicare expenditures, according to results of a new study.

“Joshua A. Roth, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, discussed the economic analysis during a press conference in advance of the American Society of Clinical Oncology (ASCO) Annual Meeting, where results will be formally presented at the end of the month. He noted that following the positive results of the National Lung Screening Trial, the US Preventive Services Task Force recently recommended LDCT screening in healthy persons between the ages of 55 and 80 with at least 30 pack-years of smoking history. Medicare, meanwhile, is expected to release a draft decision on screening coverage in November of this year. ‘That decision will likely heavily weight the Task Force’s recommendation,’ Roth said.”