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.
In the new study, Roth and his colleagues used a model to forecast the 5-year results of implementation of a screening program in comparison to no screening program. They used NLST data along with other information from the SEER database, and peer-reviewed literature. The group modeled various scenarios involving faster and slower diffusion of the program. In a scenario assuming gradual diffusion of LDCT screening (which Roth compared to how mammography was introduced), the model forecasts 54,900 additional lung cancer diagnoses, most of which are stage I. Currently, 15% of lung cancers are detected at the localized stage, but the LDCT program will raise that number to 32%.
The model also showed that an additional 11.2 million LDCT scans would be performed, with 2 million false positive results. Overall, this results in $9.3 billion in excess expenditure; the bulk of that amount, $5.6 billion, is the cost of the CT scans themselves. Another $1.1 billion is for diagnostic work-up, and an excess $2.6 billion would be spent on cancer care.
“The rate of diffusion has a great influence on the downstream expenditures,” Roth said; if the LDCT screening program is spread more rapidly, then expenditures obviously will rise much more quickly, with more cancer diagnoses occurring within the first few years of the program. Either way, he concluded, “Medicare should plan for increased expenditures.”
Clifford A. Hudis, MD, of Memorial Sloan-Kettering Cancer Center in New York and ASCO President, noted during the press conference that this expenditure increase represents about $3 per month for each Medicare member. It is important, though, to remember the caveats of such a study: “This is a model, not actual data, it makes assumptions,” Hudis said, adding that “ASCO’s guideline supports the USPSTF recommendations with regard to screening, and if anything extends them just a little bit.”