May 14, 2014 | by Nicole White
New screening guidelines for lung cancer could save thousands of lives – but it won’t come cheap, according to a mathematical model devised to estimate Medicare costs for screening seniors who fit the criteria. The findings add fuel to ongoing debate over lung cancer screening, two weeks after an advisory panel for the U.S. Centers for Medicare and Medicaid Services recommended against coverage for the screening. City of Hope's Dan Raz, M.D., co-director of the Lung Cancer and Thoracic Oncology Program, takes issue with the new mathematical model, just as he did with the panel's recommendation.
The model’s projections, which will be presented at the American Society of Clinical Oncology’s (ASCO) annual meeting on June 2, were shared publicly Wednesday. They show that implementing the screening would detect nearly 55,000 more lung cancer cases over five years, most in the potentially curable early stages. But the cost to Medicare for screening and subsequent treatment would be $9.3 billion over five years, about a $3 per month premium increase for every Medicare member, according to the projections.
Both the findings and the recommendation from the advisory panel for the U.S. Centers for Medicare and Medicaid Services are drawing criticism from lung cancer experts and patient advocates. The recommendation itself runs contrary to the judgment of the U.S. Preventive Services Task Force, which last year recommended low-dose CT screening for heavy smokers. The task force – which determines which screenings health insurance must cover – recommends annual scans for current and former smokers between ages 55 and 79 who smoked the equivalent of a pack a day for at least 30 years.
That recommendation is based on the National Lung Cancer Screening Trial, which showed a 20 percent reduction in deaths from lung cancer, the leading cause of cancer death in the United States. The primary reason that lung cancer is the most deadly cancer is because there has been no routine screening for lung cancer. Thus, the disease tends to be caught in advanced stages after it has already spread.
Raz challenges both the new study and its assumptions. He attended the panel discussion in April to present evidence supporting the benefits of Medicare coverage of lung cancer screening.
In the wake of the new findings, he said:
"The study presented in the ASCO abstract attempts to estimate costs of lung cancer screening in the Medicare population using modeling data and several assumptions.
In my opinion, this probably overestimates the costs of lung cancer screening because lung cancer screening centers are using resources more efficiently than they were during the National Lung Screening Trial. There are fewer false positives and fewer invasive procedures needed, and this means less costs.
This study also estimates the dollar cost per beneficiary to be three times what an independent actuarial group, Milliman, reported in Health Affairs using a different model. Other cost studies have shown lung cancer screening with low-dose CT scans to be less expensive than mammography or colorectal cancer screening, while the potential for lives saved is far greater with lung cancer screening."
The analysis Raz refers to found the cost would be about 76 cents per month per Medicare member, and was commissioned by the Lung Cancer Alliance.
A proposal on whether Medicare will cover the screening is expected by November of this year, with a final decision expected in early 2015.
Learn more about lung cancer treatment at City of Hope.