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November 18, 2014 — Dartmouth researchers say lung cancer screening in the National Lung Screening Trial (NLST) meets a commonly accepted standard for cost effectiveness. The relatively new screening test uses annual low-dose CT scans to spot lung tumors early in individuals facing the highest risks of lung cancer due to age and 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 65-75 years of age," says William C. Black, M.D., chair of the Lung Cancer Screening Group at Dartmouth-Hitchcock Medical Center and professor at Geisel School of Medicine at Dartmouth. Black is a leading national researcher of lung cancer screening.
The Dartmouth study found that screening costs $81,000 for each quality-adjusted year of life it produces. The statistic, known as Cost per Quality-Adjusted-Life-Years (QALYs), considers the overall costs of a medical intervention to a selected population to produce one year of perfect health. A proposed benchmark for cost-effectiveness is $100,000-$150,000 QALY.
In this study Dartmouth researchers evaluated more than 53,000 participants in the seven-year NLST, with results proving that low-dose CT screening for lung cancer can save lives. For each 1,000 people screened there were about three fewer deaths from lung cancer.
When the researchers looked at specific subgroups of study participants, they found lung cancer screening was most cost-effective for current smokers, women and for people in their sixties.
Lung cancer screening is not yet standard medical practice. For the last two years, multiple professional associations have issued statements that recommend physicians offer annual lung cancer screening to individuals 55-80 years old who have more than a 30-pack years history of smoking.
This type of screening is not without risks. In the NLST, roughly one-third of those screened 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.
U.S. Preventive Services Task Force stated in December 2013 that 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.
Since the NLST was conducted, the American College of Radiology narrowed its definitions of a "positive" lung cancer-screening test. This stricter guideline should decrease the number of false alarms resulting from the test.
For more information: www.cancer.dartmouth.edu