A cost-benefit analysis published in the August issue of American Health and Drug Benefits suggests that low-dose CT screening for patients at high-risk for lung cancer is a cost effective measure for significantly reducing lung cancer deaths. Researchers expect these findings to inform the adoption of full Medicare coverage for those patients who qualify.

The guidelines for determining who is at high-risk for lung cancer are taken from the United States Preventative Services Task Force (USPSTF), which issued a recommendation for screening asymptomatic adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the last 15 years.

Pack-years assign a numerical value to the amount of smoking one does. For example, smoking one pack a day for 15 years generates a pack value of 15, while two packs a day for 15 years generates a pack value of 30.
The Affordable Care Act requires private insurers to cover medical procedures that receive a grade of "B" or higher from the USPSTF without a co-pay. The "B" grade indicates high certainty that the net benefit is moderate, or moderate certainty that the net benefit may be substantial.

CT lung cancer screening is deemed an Essential Health Benefit, covered by many private health insurers, but Medicare beneficiaries have lesser access to these exams and increased risk of lung cancer death due to lack of coverage.

The study compiled Medicare costs, enrollment, and demographics. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures.

The study concluded that if eligible Medicare beneficiaries had been consistently screened from age 55, there would currently be 358,134 more survivors today and up to 30,000 more survivors annually. The researchers estimate 4.9 million Medicare beneficiaries would qualify for insured screening in 2014. These findings were reported by the American College of Radiology (ACR).

"CT lung cancer screening is cost-effective and significantly reduces lung cancer deaths," Dr. Ella Kazerooni, chair of the ACR Lung Cancer Screening Committee and ACR Thoracic Imaging Panel said in a statement. "Published results show no undue or lasting patient anxiety from the screening process. It is time for Medicare to cover CT lung cancer screening."

The report states that without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of three years. Lung cancer remains the leading cause of cancer death in the United States and the world. The American Cancer Society estimates there will be 159,260 deaths from lung cancer in the United States this year.

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