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Health August 2012

Aid for Age

Lung Cancer Screening Proves Valuable Despite Lack of Most Insurance Coverage

By Tait Trussell

The study also determined that if such screening had been in place for the past 15 years that  about130,000 people around age 65 would be alive today. The cost per life-year saved would be lower than screening for breast and cervical cancer.

Thousands of lives a year could be saved from the most lethal form of cancer, with proper screening.

So says the first-of-its-kind actuarial study, published in the journal Health Affairs. Cancer in the lungs causes more than 150,000 deaths a year in this country, making it the deadliest form of cancer. Between 2003 and 2007, some 792,495 lives were lost to lung and bronchial cancer according to the National Cancer Institute. It strikes seniors most often. Smoking, of course, is the primary cause.

Most insurance companies, however, don’t offer coverage for lung cancer screening for high-risk people, even though such tests can detect early stage tumors, the study said.

“These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer,” according to the study’s lead author, Bruce Pyenson. He’s an actuary and principal at the office of Milliman, a consulting and actuarial firm in New York.

“The evidence of the advantage of advanced screening technology for lung cancer has accumulated to the point where we can show very strong evidence for the commercial population.” Not only can cancer mortality be reduced for the first time in years, but it can be done in a cost effective manner,” he added.

The costs and benefits of providing lung cancer screening were examined through widely available low-dose spiral computed tomography (CT) to smokers and long-term former smokers -- seniors at high risk of developing lung cancer. Computed tomography uses X-rays to produce multiple images and a computer to put them all together.

The study said that most private insurers don’t cover this type of screening because – until now -- the cost-benefit evidence has been scarce.

A team created a model of insurer costs. They assumed approximately 18 million seniors 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, also known as a helical CT scan, can be as low as $180.

Assuming costs at about that level, the researchers found that the screening would cost the insurance companies about $247 annually per member tested. When the total expense of screening was spread over the whole insured population, the cost was calculated, remarkably, to be less than $1 per month per insured member.

The study also determined that if such screening had been in place for the past 15 years that about 130,000 people around age 65 would be alive today. The cost per life-year saved would be lower than screening for breast and cervical cancer.

Pyenson said “The screening process offers a good value for the money and it saves lives. Late- stage cancer is deadly, but treated at an early stage, survival is very good. That’s what makes early detection so promising.”

Such CT technology has evolved rapidly over the past several years. It now can identify suspicious nodules as well as be used to determine growth patterns that indicate likely malignancies.

The authors of the study emphasized the importance of efficient implementation of lung cancer treatment, including insurers’ selection of high-quality providers, use of best practices for managing clinical aspects of screening, and rigorous tracking of outcomes. Cancer screening with embedded continuous quality improvement can prove how care breakthroughs and advance technology “do not have to feed cost escalation,” Pyenson said.

According to the National Institute for Cancer, breast cancer is the second most common cancer in women in the U.S., after skin cancer. Prostate cancer is the second leading cause of death in men, after lung cancer.

The National Cancer Institute (NCI) last year found from a large trial that screening with the technology computed tomography scans can reduce the risk of death from lung cancer. But it did not attempt to figure possible cost savings, as did the actuarial study.

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Tait Trussell is an old guy and fourth-generation professional journalist who writes extensively about aging issues among a myriad of diverse topics.

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