Feature: NLST researchers aim to answer cost questions

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With preliminary results linking CT screening with a 20 percent decrease in lung cancer mortality compared with chest x-ray, the National Lung Screening Trial (NLST) research team has turned to secondary endpoints of the trial and started to analyze cost data. Early estimates suggest that CT screening could be cost-effective if providers follow the NLST protocol, William C. Black, MD, director, chest imaging at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and NLST co-principal investigator, told Health Imaging.

“One of the most common responses [after the release of the results] was to ask if screening was going to be cost-effective. There was concern that screening would be prohibitively costly,” said Black.

Black, who is leading the cost-effectiveness analysis, had hoped to report numbers at the American College of Radiology Imaging Network annual meeting Sept. 21–23. However, researchers are still in the process of arranging data. Rough “back of the envelope” estimates based on data consistent with NLST indicated that it was plausible that screening could be performed in the $50,000 per quality-adjusted life year range, he told Health Imaging.

However, Black emphasized that the estimate is rough and tied to the NLST protocol, i.e. annual screening in a high-risk population of current and former smokers ages 55 to 75 who are medically fit for treatment if a lung cancer is detected.

The initial cost-effectiveness analysis will be based on the societal, rather than institutional, perspective of screening costs and consider downstream costs, workup of suspicious findings and complications and treatment, he explained.

NLST applied a fairly conservative approach to nodule work-ups, he said, which is key to the cost-effectiveness of any lung cancer screening program. “Only 3 percent of patients with positive CT scans were referred for invasive procedures, such as biopsy or surgery, in NLST,” he said, urging physicians to follow findings before ordering any invasive procedure.

Black noted that there are a variety of approaches to screening and that following the initial cost-effectiveness analysis, the next step will be to apply a series of what-if scenarios that consider screening in the context of a different population, different intervals, different follow-up protocols and different treatments.

Black expects that the earliest that crude cost estimates could be submitted for publication is January 1, 2012.