The U.S. Preventive Services Task Force (USPSTF) recommendations advise annual low dose computed tomography (LDCT) screening for lung cancer in high-risk patients. Now a new study, which is the first to focus on the Medicare population, projects that implementing this screening policy in the Medicare program could result in approximately 54,900 more lung cancer cases detected over a five-year period.
Medicare Population Has Highest Incidence of Lung Cancer
The Medicare population has the highest incidence of lung cancer, and a large proportion of members qualify for screening. The new screening model projects an estimated increase in the proportion of early-stage diagnoses from 15 percent to 33 percent over five years.
Lead study author Joshua Roth, Ph.D., MHA, at the Hutchinson Institute for Cancer Outcomes Research, noted in a press statement that lung cancer is the leading cause of cancer death in the U.S., mainly because lung cancers often aren't caught until they are at an advanced stage.
“If we can periodically look for and detect cancer earlier, that allows for potentially curative surgery and, generally, a much better survival prognosis,” Roth said.
Screening Healthy People Aged 55 to 80
The USPSTF recommends annual LDCT screening in healthy people aged 55 to 80 who have a history of smoking 30 packs of cigarettes a year, who currently smoke, or who have quit in the past 15 years. The recommendations are based on findings from the National Lung Cancer Screening Trial, which show a 20 percent reduction of lung cancer deaths with LDCT screening compared to X-ray screening.
Higher Costs Associated with Screenings
According to the study, the model predicts that over a five-year period, an additional 20 percent of high-risk patients would be offered screening each year. If the new guidelines were implemented, it could result in a cost increase of $9.3 billion over the next five years.
The breakdown of costs would include $5.6 billion more spent on low-dose CT imaging, $1.1 billion for diagnostic workups, and $2.6 billion more in cancer care expenditures. The total five-year Medicare expenditure would translate to a three-dollar per-month premium increase per Medicare member.
Commenting on the study, Benjamin Levy, M.D., assistant professor of Medicine, Hematology and Medical Oncology, Icahn School of Medicine, told Healthline, "The NLST was the first to show a reduction in lung cancer mortality with any screening modality. The results of this study should be reinforced by the staggering statistic that up to 65 percent of lung cancer patients present with advanced stage disease where costly therapies only lead to months in improvement in survival with very few, if any, cures. Thus, the potential increase in Medicare premiums needs to be put in context of how costly it is to treat these patients once they have advanced stage disease.”
In order to assist healthcare systems to prepare for the implementation of the USPSTF screening policy, the researchers are planning to look at available resources and demand for additional scanners and technologists if Medicare decides to cover screening. A draft decision on Medicare coverage is expected to be posted in November.
Roth concluded that the program's success will depend on ensuring that those who are at high risk actually undergo screening and subsequently receive appropriate treatment.