Lung cancer screening could be cost effective: Study finds

By Dr. Ananya Mandal, MDApr 11 2012

A new study shows that screening longtime tobacco users for lung cancer would be less costly than the widely accepted practice of screening for breast, cervical and colorectal cancers and would reduce the death toll of lung cancer by an estimated 15,000 lives a year.

The researchers – a group of actuarial economists from Rush University – used financial standards generally employed by health insurance companies, to calculate the cost effectiveness of annual low-dose CT scans of middle-aged Americans who have smoked the equivalent of a pack of cigarettes every day for 30 years. They found it would cost each insured American an extra 76 cents a month. That investment could give each person whose lung cancer was caught early an extra year of life, at a cost of $18,862 per patient, the economists wrote in the journal Health Affairs.

The analysis published Monday focused on men and women between 50 and 64 — old enough to be long-term smokers but too young to be covered by Medicare. The study assumes that only half of those eligible to receive lung cancer screening will actually do so. Based on the results of the cancer institute trial, the economists figured that 4 out of 10 smokers would be referred for follow-up medical tests at least once every three years before being declared cancer-free.

The figures put CT scanning for lung cancer on a par with colonoscopy testing for early detection of colorectal cancer, the study found. Both tests are cheaper than the mammograms and Pap tests that most health insurers pay for to screen for breast and cervical cancer. “This screening process offers a good value for the money, and it saves lives,” said study leader Bruce Pyenson, a principal with the consulting and actuarial firm Milliman Inc. in New York.

Less than a year back another set of researchers reported in the New England Journal of Medicine that annual CT scans of longtime smokers could reduce lung cancer deaths by 20 percent without causing excessive harm to patients whose readings turned out to be false positives. Those findings were based on a clinical trial involving more than 53,000 smokers that was funded by the National Cancer Institute.

But so far, very few private insurers have offered to pay for the screenings. Experts who weren’t involved with the Health Affairs study said the new calculations were not likely to cause insurers to change their practices immediately.

“They make a valid point that lung cancer screening is probably a good use of our limited health care dollars,” said Dr. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society. “However, it’s also fair to say they attached a very high benefit to lung cancer screening.” The study will start a debate over the value of lung cancer screening and its impact on health care spending, but it’s hardly the last word on the subject, Lichtenfeld said. “It will still be some time before we have definitive answers,” he said.