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Report: New Screening Guidelines Catch Lung Cancer Early, But at a High Cost

Early detection could bring cost increase of $9.3 billion over 5 years

If Medicare implements new lung cancer screening recommendations for annual low-dose computed tomography (CT) scans for high-risk patients, a lot of lives could be saved, but the price tag could be high, a new report suggests.

Researchers projected that about 55,000 more lung cancer cases, many of them early-stage disease, will be detected over a 5-year period. But implementing the new U.S. Preventive Services Task Force guidelines could result in a cost increase of $9.3 billion over the next 5 years, researchers predicted in a report released ahead of the annual meeting of the American Society of Clinical Oncology.

The task force recommended annual low-dose CT screening in healthy people aged 55 to 80 years who have a history of smoking a pack of cigarettes a day for 30 or more years, following a report from a large study showing that this strategy might reduce deaths from lung cancer by 20%.

Lung cancer is the leading cause of cancer death in the U.S. That’s mainly because lung cancers often aren’t detected until they are at a late stage, said Dr. Josh Roth, study co-author and a postdoctoral fellow at the Fred Hutchinson Cancer Research Center.

Patients who are diagnosed at an advanced stage of disease have a 5-year survival rate of 4%, Roth said. Currently, 57% of lung cancer patients are diagnosed at that stage. In contrast, a patient who is diagnosed with localized cancer has a 5-year survival rate of 54%.

The task force’s guidelines will be implemented by insurers participating in the Patient Protection and Affordable Care Act, Roth said. But Medicare hasn’t yet signed on.

While Medicare officials were mulling the decision, Roth and his colleagues thought it might be helpful if they could determine what the benefits and cost of implementing screening might be.

“We determined that if it was implemented, over 5 years 54,900 more people would be diagnosed, the vast majority at stage 1,” Roth said.

That represents an increase in the proportion of cancers diagnosed at an early stage from 15% to 33%. But the cost would be significant.

“Over 5 years, there would be about $5.6 billion more spent on low-dose imaging, $1.1 billion for diagnostic workups, and $2.6 billion more in cancer care expenditures,” Roth said. “So, that all adds up to $9.3 billion in additional expenditure over 5 years.”

Those costs will need to be offset either by a reduction of other services or by an increase in premiums, Roth said.

“Let’s say there is no cost offset elsewhere. That means that there will need to be an increase of $3 per member per month to cover this,” he added. “That’s the bottom line.”

Source: Fred Hutchinson Cancer Research Center; May 14, 2014.

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