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Dartmouth Report: Lung Cancer Screening With Low-Dose CT Could Be Cost-Effective

Findings add to debate over early cancer-detection methods

Researchers at Dartmouth University say lung cancer screening in the National Lung Screening Trial (NLST) meets a commonly accepted standard for cost-effectiveness, as reported November 6 in the New England Journal of Medicine. This relatively new screening test uses annual low-dose computed tomography (CT) scans to spot lung tumors early in individuals with the highest risks of lung cancer because of age or smoking history.

“The takeaway from this study is that there is potential for lung-cancer screening to be done in a cost-effective manner, particularly for adults 65 to 75 years of age,” said principal author William C. Black, MD.

The study found that screening costs $81,000 for each quality-adjusted life-year (QALY) it produces. QALY statistics define the overall costs of a medical intervention required in a selected population to produce 1 year of perfect health. For policy makers, this ratio establishes relative worth from an economic perspective. A proposed benchmark for cost-effectiveness is $100,000 to $150,000 per QALY.

When the researchers looked at specific subgroups of study participants, they found lung cancer screening was most cost-effective for current smokers, for women, and for people in their sixties.

Lung cancer screening is not yet standard medical practice. Over the last 2 years, multiple professional associations have issued statements recommending that physicians offer annual lung cancer screening to individuals 55 to 80 years old who have more than a 30-pack-years history of smoking.

As a result of a positive recommendation from the U.S. Preventive Services Task Force in December 2013, commercial insurers will be required to cover the test as a preventive service with no co-pays or deductibles. The Centers for Medicare and Medicaid Services (CMS), however, has yet to issue its final decision on reimbursement. A preliminary panel recommended against coverage by CMS this past spring. The final report from CMS is expected in the next week.

In the new study, Dartmouth researchers evaluated more than 53,000 participants in the 7-year NLST. This randomized controlled study was credited for proving that low-dose CT screening for lung cancer can save lives. For each 1,000 people screened, approximately three fewer deaths from lung cancer occurred. The NLST followed strict protocols, and the results of the study do not necessarily apply to lung cancer screening programs implemented differently, the authors noted.

Lung cancer screening is not without risks. In the NLST, roughly one-third of screened individuals had a “false alarm” requiring further testing, usually a repeat of the CT scan, to rule out lung cancer. Some additional tests are invasive and come with a small risk of serious complications.

Since the NLST was conducted, the American College of Radiology narrowed its definition of a “positive” lung-cancer screening test. This stricter guideline should substantively decrease the number of false alarms resulting from the test, according to the investigators.

Sources: Norris Cotton Cancer Center; November 10, 2014; and NEJM; November 6, 2014.

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