Annual CT scans are a cost-effective way to screen long-term smokers for… (Stefano Paltera For The…)
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, according to a study released Monday that is likely to ignite debate on expanding healthcare coverage for smokers.
Using the financial standards generally employed by health insurance companies, a group of actuarial economists calculated that annual low-dose CT scans of middle-aged Americans who have smoked the equivalent of a pack of cigarettes every day for 30 years 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 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.
It's been less than a year since doctors reported in the New England Journal of Medicine that annual CT scans of longtime smokers could reduce lung cancer deaths by 20% 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 — at least not yet.
Some of the assumptions used in the calculations were rosier than the results that emerged from the National Cancer Institute study, they said. For instance, they noted, the economists may have overstated the ability of CT scans to detect lung cancers early and overestimated the value of early detection in preventing lung cancer deaths.
"They make a valid point that lung cancer screening is probably a good use of our limited healthcare 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 kick off an informed debate over the value of lung cancer screening and its impact on healthcare 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.
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.
Economist Emmett Keeler of Rand Corp. in Santa Monica is working on another study that assesses the costs and benefits of lung cancer screening. He said his team was basing its cost estimates on the more modest survival figures documented in the cancer institute study.
The Health Affairs study, by contrast, relies on data generated from earlier observational studies, which failed to take into account that some lung cancers detected by screening might never have progressed to life-threatening metastatic cancer, Keeler said. The economists may also underestimate the extent and cost of "work-ups" that can follow a false-positive test result, he added.
"Modern technology has raised the possibility that we can, for the first time, really do something about lung cancer," Keeler said. "The fact that some of the details of what they did aren't right doesn't mean this is something people can afford to dismiss. ... Our numbers are probably not going to be as big as theirs. Will it be enough? We'll see."
Ultimately, he said, the decision about whether to institute lung cancer screening will be a political decision as much as a financial and medical one.