Insurance Coverage of CT Screening for Lung Cancer Cost Effective

April 10, 2012
Marijke Vroomen Durning, RN

CT screening for lung cancer could save thousands of lives if routinely covered by insurers, according to a Health Affairs study.

CT screening for lung cancer and follow-up care of older long-term smokers could save thousands of lives if routinely covered by insurers, researchers said in a study published in the April issue of Health Affairs.

Bruce Pyenson, an actuary and lead author of the study said that effective screening could significantly affect cancer lung cancer mortality in a cost-effective manner. Unfortunately, most insurance companies do not offer lung cancer screening for high-risk individuals while the costs for treatment are still low if cancer is detected early.

“These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer,” said Pyenson. “Late stage lung cancer is deadly, but if treated at an early stage, survival is very good – that’s what makes early detection so promising.”

The first-of-its-kind actuarial study examined the costs and benefits of lung cancer screening using low-dose spiral CT for smokers and long-term former smokers, aged 50 to 64. By modeling insurer costs, assuming about 18 million people were high risk and half would be screened if the benefit was available through private insurance, the researchers found that screening would cost the insurance companies about $246 per member if tested every year. Spread over the commercially insured population, the total screening expense was under $1 per insured person per month.

The researchers estimated that had the screening been available since 1997, 130,000 more people under the age of 65 would be alive today, in addition to more people over 65. The cost per life-year saved would be lower than screening for cervical and breast cancer and comparable to the cost per life-year saved of screening for colorectal cancer, researchers said.

This study follows last year’s published results by the National Cancer Institute, which showed that screening with CT can reduce the risk of dying from lung cancer.

“Rolling out lung cancer screening with embedded continuous quality improvement can prove how care breakthroughs and advanced technology do not have to feed cost escalation,” Pyenson concluded.

The Medical Imaging and Technology Alliance commended the analysis, saying if offers “compelling evidence” that lung cancer screening has the potential to save lives and cost. Gail Rodriguez, MITA’s executive director, said in a statement, “This analysis reinforces the value of advanced medical imaging technologies to improve patient outcomes and drive down health care spending.”

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