Lung cancer screening would save thousands of lives at a relatively low cost if such tests were routinely covered by commercial insurers, according to a first-of-its-kind actuarial study in the April issue of Health Affairs.
Lung cancer causes more than 150,000 deaths each year, making it the most lethal cancer in the United States. Yet most insurance companies do not offer coverage for lung cancer screening for high-risk individuals, even though these tests can pick up early stage tumors.
“These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer,” said lead author Bruce Pyenson, an actuary and principal at the New York office of Milliman, a consulting and actuarial firm. “The evidence of the value of advanced screening technology for lung cancer has accumulated to the point where we can show very strong cost-effectiveness for the commercial population. We can also jump the needle on cancer mortality for the first time in years, and do so in a cost-effective manner.” The study by Pyenson and coauthors is one of several articles in the April Health Affairs volume that deal with issues concerning value, cost, and quality in cancer care.
The Pyenson study examines the costs and benefits of providing lung cancer screening through widely available low-dose spiral computed tomography (CT) to smokers and long-term former smokers ages 50 to 64—people at high risk of developing lung cancer. Most private insurers do not cover this screening because the evidence on the cost-benefit front has been scarce or conflicting, until now.
Pyenson and coauthors modeled insurer costs, assuming about 18 million people fell into that high-risk category and about half would get the screening if it were a covered benefit. Managed care reimbursement for a spiral CT, for example, can be as low as $180. Assuming costs around that level, the researchers found that the screening would cost insurance companies about $247 per member tested annually. When the total expense of screening was spread over the commercially insured population, the cost was under $1 per insured member per month.
If such screening had been in place for the last 15 years, 130,000 more people under age 65 would be alive today, plus additional people over age 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, according to the study.
“This screening process offers a good value for the money and it saves lives,” Pyenson said. “Late stage lung cancer is deadly, but if treated at early stage, survival is very good—that’s what makes early detection so promising.”
Just last year, for example, the National Cancer Institute published results from a large randomized controlled trial that showed that screening with a technology called computed tomography or CT scans can reduce the risk of dying from lung cancer. Such CT technology has rapidly evolved over the last 15 years and now can both identify small, suspicious nodules and be used to determine growth patterns that indicate likely malignancies, Pyenson said.
This study includes limitations. For example, the cost could be higher and the benefits lower if screening tests are not conducted according to best practice guidelines for price and follow-up.
Accordingly, the authors emphasize the importance of efficient implementation of lung cancer screening, including insurers’ selection of high-quality providers; use of best practices for managing clinical aspects of screening, especially if lesions are found; and rigorous tracking of outcomes. “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 added.
The cluster of articles on cancer care in the new Health Affairs issue was supported by Bristol-Myers Squibb, the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, and the consulting firm Precision Health Economics.