Costs Associated with Lung Cancer Screening for Medicare Patients

Chicago—A forecasting model of Medicare enrollees found that after 5 years, low-dose computed tomography (LDCT) lung cancer screening would result in 55,000 more lung cancer diagnoses, 11 million more LDCT scans, and $9.3 billion more in direct medical expenditures or $3 per-member, per-month (PMPM). The costs would lead to an increased $5.6 billion in screenings, $1.1 billion in diagnostic workups, and $2.6 billion in cancer care expenditures.

Joshua Roth, PhD, the study’s lead author, presented the results during an oral abstract session at the ASCO meeting. Genentech, Inc., funded the trial. The study’s authors were also working on a study examining the cost-effectiveness of LDCT screening in Medicare patients at the time of the presentation.

Dr. Roth said lung cancer is the leading cause of cancer death in the United States and is often detected at an advanced stage when patients have poor survival prognosis. He mentioned screening could be helpful in reducing deaths.

“Periodically checking high-risk patients for lung cancer can catch cancers before they spread and thereby confer more favorable survival prognosis,” Dr. Roth said.

Dr. Roth cited the National Cancer Institute-sponsored National Lung Screening Trial that began in 2002 and included 53,454 patients 55 to 74 years of age who were current smokers or had quit within the past 15 years. They were randomized to 3 years of screening with LDCT screening or chest X-ray. The study found that lung cancer mortality was reduced by 20% in patients who underwent LDCT.

In 2013, the United States Preventive Services Task Force (USPSTF) performed a systematic review of lung cancer screening and initiated modeling studies. The USPSTF recommended LDCT screening for healthy people 55 to 80 years of age who had a 30-year smoking history and who were current smokers or had smoked within the past 15 years. A draft decision on whether Medicare will cover LDCT screening is expected in November, according to Dr. Roth. However, in April, the Medicare coverage advisory committee voted against covering LDCT screening because of the uncertainty of screening outside of clinical trials.

This study was developed to project the 5-year clinical, resource, and budget impacts of implementing LDCT screening. The model assumed 20% of high-risk patients would be offered screening each year. In the best case scenario, the authors assumed 50% of patients who are offered screening would undergo the screening each year.

The authors also examined 2 other scenarios. In the rapid LDCT screening diffusion scenario, the authors assumed 75% of patients who are offered screening would undergo the screening each year. In that case, the 5-year costs would increase $12.7 billion, or $4.10 PMPM. In the slow LDCT screening diffusion scenario, the authors assumed 25% of patients who are offered screening would undergo the screening each year. In that case, the 5-year costs would increase $5.9 billion, or $1.90 PMPM.

Dr. Roth said the average cost per screening episode was approximately $500. The authors defined a screening episode as a prescreening office visit, computed tomography (CT) scan, postscreening office visits, smoking cessation counseling, and smoking cessation intervention.

The authors found that PMPM costs would be $1.30 if the cost per screening episode was $100 and $3.70 if the cost per screening episode was $700.

“We could disagree about the cost per specific episode, but I think we would all agree that this is a large impact and something we need to think about,” Dr. Roth said. “Implementing CT lung cancer screening is almost certainly going to increase Medicare expenditures. This is really because the additional costs of doing millions of screening [examinations] is much greater than the potential cancer care savings from a stage shift.”

There were several limitations to the study, according to Dr. Roth. The model assumed findings from the National Lung Screening Trial are generalizable to Medicare enrollees and that patients who receive screening are consistent with the USPSTF’s high-risk group, which may not be true. The authors also only examined 5 years of data, and Dr. Roth said results could differ over a longer period of time.—Tim Casey