Lung cancer screening as an insurance benefit in high-risk populations could save thousands of lives with costs that compare favorably to other cancer screenings, and commercial insurers should consider the practice to be high-value coverage, according to an actuarial study published in the April issue of Health Affairs.
"These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer," said Bruce Pyenson, an actuary and principal at the New York City office of Milliman, a consulting and actuarial firm, in a statement. "The evidence of the value of advanced screening technology for lung cancer has accumulated to the point where we can show very strong cost-effectiveness for the commercial population. We can also jump the needle on cancer mortality for the first time in years, and do so in a cost-effective manner."
The authors noted that lung cancer screening is not established as a public health practice despite the fact that lung cancer causes more than 150,000 deaths per year and the results of the National Lung Screening Trial have shown that screening with low-dose spiral CT reduces mortality. Most private insurers do not cover CT screening because evidence of its costs and benefits had been lacking.
Pyenson and colleagues wanted to investigate the cost and benefits of providing lung cancer screening with low-dose spiral CT to people at high risk of lung cancer—smokers and long-term former smokers ages 50 to 64. They modeled insurer costs, assuming approximately 18 million people were in the high-risk category and about half would undergo screening if it were a covered benefit. When current commercial reimbursement rates for treatment were assumed, the cost of screening were about $1 per insured member per month.
The study found that 130,000 more people under the age of 65 would be alive today had such screening been in place during the past 15 years. Costs per life-year saved would be lower than screening for cervical and breast cancer, and comparable to the costs of colorectal cancer screening.
Pyenson et al assumed low managed care reimbursement, which means costs could be higher and benefits lower if screening tests were not conducted according to best practice guidelines for price and follow-up. Because of this potential limitation, the authors suggested that “payers and patients should demand screening from high-quality, low-cost providers, thus helping set an example of efficient system innovation.”
In addition to seeking out low-cost providers, the authors suggested increasing the efficiency of lung cancer screening by using “volume change analysis” as a filter for cancer. This technique measures the growth of suspicious nodules over a defined time period, which has been shown to reduce the need for invasive diagnostic procedures and, as a result, reduces costs and frequency of complications. Tobacco cessation counseling offered at screening was also included in the cost calculation since tobacco use is the leading cause of lung cancer and quitting can improve overall public health.
"This screening process offers a good value for the money and it saves lives," Pyenson said. "Late stage lung cancer is deadly, but if treated at early stage, survival is very good--that's what makes early detection so promising."