CT Screening for Lung Cancer Cost-Effective
That figure is lower than the cost of breast, colorectal, and cervical cancer screening, they said, largely because fewer lung screens involve a biopsy, and because the target population is high-risk and thus smaller than the broader populations that have the other screenings.
How do you screen for lung cancer?
The only method proven to be effective in finding lung cancer early and reducing the number of lung cancer deaths in people at high risk is computed tomography (CT) screening. In November, 2010, the National Cancer Institute’s (NCI) eight year long, randomized controlled trial of 53,000 person at high risk for lung cancer was halted as soon as 20% fewer deaths occurred among those screened with CT scans than those screened with chest x-rays.
To put this profound benefit in perspective, the overall reduction in breast cancer deaths by mammography screening is estimated to be 15%.
Compared to no screening at all and with the advances in imaging, surgical treatments and diagnostic methods that have occurred since the NCI trial was started in 2002, the actual mortality benefit (number of deaths that can be avoided) of CT screening is probably closer to 50%.
However, as with all screening procedures, there are risks involved. This is discussed in “What are the risks involved.”
Research is ongoing to find biomarkers in the blood, urine, breath or sputum that would give an early indication that lung cancer may be present, or to find a genetic clue that a person is predisposed to lung cancer. Accomplishing this is proving to be more elusive and complicated than initially thought and may take decades to realize, as the Director of the National Cancer Institute noted in his recent book. A recent paper indicated that a single lung cancer in a single patient was found to have 50,000 genetic mutations. Yet there are promising research avenues that may enhance routine detection of early, curable lung cancer.
They also calculated that screening would lead to more than 130,000 additional lung cancer survivors in 2012.
Given those parameters, they estimated that the cost per life-year saved would be $19,000, which was on par with colorectal cancer screening, and less expensive than screening for cervical or breast cancer (about $50,000 and $31,000, respectively).
“We can jump the needle on cancer mortality for the first time in years, and do so in a cost-effective manner,” Pyenson said in a statement.
The researchers noted, however, that the results of NLST were published after this analysis was completed. This model’s estimates of the proportion of early-stage lung cancer that would be detected by screening, and of mortality reduction as a result of screening, are more optimistic than the results of NLST, they said.
Yet they said their patient population started at a younger age than the NLST (at age 50 instead of 55), which would have yielded fewer cancers per screened patient, potentially raising screening costs while lowering benefits.
Setting the cutoff at age 64 also underestimates cost advantages, they said, because it ignores savings after age 65.
This analysis had some other limitations: the model did not address the cost and logistics of implementing a widespread screening program. The researchers also did not factor in the cost of a possible initial surge of treatment from earlier detection, as screen-detected cancers appeared in addition to symptom-detected cancers.
“Implemented with appropriate quality and standardization processes, the screening could serve as an example of system innovation that greatly improves health outcomes without feeding cost escalation,” they concluded.
Primary source: Health Affairs
Source reference: Pyenson B, et al “An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost” Health Affairs 2012; 31: 770-779; DOI: 10.1377/hlthaff.2011.0814.
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By Kristina Fiore, Staff Writer, MedPage Today