The evidence exists that low-dose CT can save the lives of patients at high risk for lung cancer, according to MITA.
Should Medicare beneficiaries have access to the same testing benefits as individuals with private health insurance? That question is at the crux of Medicare’s deliberation of a coverage decision for imaging high risk beneficiaries for lung cancer. Unfortunately, a Medicare advisory panel recently concluded that while low-dose CT (LDCT) could save thousands of lives, the benefits are insufficient to recommend coverage. This conclusion is surprising and disappointing, particularly given the evidence that indicates exactly the opposite.
LDCT is an advanced imaging technology that can detect tumors as small as a grain of rice. Compared to a standard chest X-ray, LDCT can reduce lung cancer deaths by 20 percent. The groundbreaking National Lung Screening Trial (NLST) also determined that 12,000 deaths could be avoided every year if high-risk patients underwent a LDCT scan.
In addition, data show that LDCT for patients at high risk of lung cancer is cost effective. An actuarial cost-benefit analysis published in the peer reviewed journal Health Affairs found that coverage of LDCT for lung would cost about $1 per insured member per month in 2012 dollars. The cost per life-year saved would be less than $19,000, an amount that is at least as cost effective as other essential screening tests including breast, cervical and colorectal cancer screenings. Furthermore, an analysis of NLST data presented at a Joint Meeting of the National Institutes of Health Board of Scientific Advisors and National Cancer Advisory Board in June 2013 also concluded that LDCT for patients at high risk for lung cancer is a cost effective diagnostic tool.
These data are even more dramatic considering that nearly 400,000 Americans are living with lung cancer. This year alone, an estimated 159,260 Americans are expected to die from lung cancer, accounting for approximately 27 percent of all cancer deaths. Nearly two decades ago, lung cancer surpassed breast cancer as the leading cause of cancer-related deaths among women and now, the disease is the leading cancer killer in both men and women in the United States.
One reason lung cancer is so deadly is that symptoms of the disease do not typically manifest until it has reached advanced stages. In approximately 40 percent of people diagnosed with lung cancer, the diagnosis is made after the disease has advanced. In one-third of those diagnosed, the cancer has reached stage three.
Given the prevalence of lung cancer and the proven effectiveness of LDCT, it’s not surprising that military hospitals began phased implementation of these scans to detect lung cancer in its earliest, most treatable stages. In November of 2013, the Naval Medical Center San Diego joined Walter Reed National Military Medical Center in Bethesda, Md., and Naval Medical Center, Portsmouth, Va., using NLST criteria. The Department of Veterans Affairs (VA), the Department of Energy (DoE) and a number of private insurers, such as WellPoint, Blue Cross Blue Shield affiliates and Anthem affiliates, have also followed.
Several cancer organizations that represent diverse groups of patient advocates across the country have also voiced strong support for coverage, including the American Association for Thoracic Surgery (AATS), the American Society of Clinical Oncology (ASCO), the American Cancer Society (ACS), the American College of Clinical Pharmacy (ACCP) and the Lung Cancer Alliance (LCA).
Perhaps the voice that rings loudest in support of LDCT coverage is that of the U.S. Preventive Services Task Force (USPSTF). In January of this year, USPSTF finalized its recommendation for the use of annual LDCT scans for individuals ages 55 to 80 who are at high risk for lung cancer. Because the final USPSTF statement was put into place before 2014, all private insurance payers will be required to cover the screening by January 2015.
The medical imaging community stands ready to implement life-saving LDCT so that Medicare beneficiaries can access the benefits already enjoyed by those with private insurance. This includes resources – such as the American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS) quality assurance tool – to ensure physicians have the support they need to provide this service. The tool is designed to standardize LDCT reporting and management recommendations, reduce confusion in LDCT interpretations and facilitate outcome monitoring.
From a technology perspective, medical imaging manufacturers have developed equipment that is able to perform LDCT scans at an even lower dose than the rates from the NLST trial. The availability of these technologies is already widespread: CT equipment able to perform low-dose scans is available in community settings throughout the country.
The Centers for Medicare & Medicaid Services (CMS) is set to issue its proposed Medicare reimbursement determination in mid-November, with a final determination in February 2015. This decision has the potential to save tens of thousands of lives right now. Time is of the essence.