CT screening for lung cancer could become feasible
Screening with CT may detect more than 50% of lung cancers at an early stage, according to early trial results. Finding disease is one thing, however. Improving survival rates is another.
If CT screening helps reduce mortality rates, it may be cost-effective, despite the considerable expense, according to a Florida study published in the May issue of the Journal of the American College of Chest Physicians.
Currently, less than 15% of lung cancers are detected early. Despite advances in diagnosis and treatment, survival rates have improved little in the last four decades.
Research with a population model suggests that if screening can find 70% of all lung masses at a local, treatable stage, the expected cumulative costs per patient, including treatment, would be about $65,280. Survival prospects would be slightly more than 39 months. Under the same conditions, a patient undergoing no screening would cost an average $66,300, with an average life expectancy of less than 12 months.
Due to the lack of conclusive data on lung cancer screening with CT, researchers used a model that tried to simulate a randomized clinical trial using diverse data, said Dr. Robert Clark, chair of radiology at the University of South Florida?s H. Lee Moffitt Cancer Center and Research Institute. The hypothetical study group received five rounds of screening over a 15-year period.
?We don?t have any long-term scientific data,? Clark said. ?The studies that are going on will get that, but it will take 15 years or so. So we tried to create a model that essentially simulates a randomized clinical trial with existing data.?
The study used data from several sources: · from Medicare to establish the unit costs for treatment · from the Surveillance, Epidemiology, and End Results (SEER) trial of the National Cancer Institute to identify outcomes and survival rates · from current clinical trials for resource utilization
The main obstacle to CT screening is cost. There are 25 million smokers and former smokers in the U.S. who are eligible for screening, Clark said. Based on Medicare reimbursement rates for CT, the overall screening and diagnostic costs would be close to $20 billion in the first year alone.
?To put this in perspective, the total radiology-medical imaging costs for the entire year of 1990 were $22 billion,? he said.
But if screening with CT proves to be influential in lowering the death rates for lung cancer, it may become an efficient and cost-effective approach, Clark said.
