A study published in the April issue of Health Affairs reveals that thousands of lives could be saved at a fairly low cost if commercial insurers routinely covered lung cancer screening.

In the United States, lung cancer is the leading cause of cancer deaths each year – killing over 150,000 individuals. However, the majority of insurance companies do not provide coverage for lung cancer screening for people at high-risk, despite the fact that these tests can detect early stage tumors.

Lead author of the study, Bruce Pyenson, an actuary and principal at the New York office of Milliman, a consulting and actuarial firm, explained:

“These results demonstrate the cost efficiency of offering this benefit to people who are at high risk of lung cancer.

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 researchers conducted the study in order to examine the costs and benefits of providing lung cancer screening through low-dose computed tomography (CT) to individuals who smoke, and long-term former smokers, aged between 50 to 64 years old. These individuals are considered to be at high risk of developing lung cancer.

Until now, there has been insufficient or conflicting evidence regarding the cost-benefit front and as a result the majority of private insurers do not cover lung cancer screening.

The team modeled insurer costs on the assumption that approximately 18 million individuals are at high-risk and about half of these people would undergo screening if it were a covered benefit. For instance, managed care reimbursement for a spiral CT can be as low as $180. Using this figure, the team discovered that lung cancer screening would cost insurance companies around $247 per member tested each year.

In addition, when the team spread the total cost of lung cancer screening over the commercially insured population, they found that the cost was under $1 per insured member per month.

Results from the study indicate that if lung cancer screening was covered by insurers, it would save the lives of 130,000 individuals under the age of 65 during a 15 year period. Furthermore, the cost per life-year saved would be lower than breast or cervical cancer screening and similar to the cost per life-year saved of screening for colorectal cancer.

Pyenson said:

“This screening process offers a good value for the money and it saves lives. Late stage lung cancer is deadly, but if treated at early stage, survival is very good – that’s what makes early detection so promising.”

For instance, in 2011, results from a large, randomized controlled trial were published by the National Cancer Institute demonstrating that screening with CT scans can reduce the risk of lung cancer mortality. Over the last 15 years, CT technology has quickly evolved and can now identify small, suspicious nodules and also be used to determine growth patterns that indicate likely malignancies.

The researchers note study limitations, for instance, the benefits of screening could be lower, and the cost more expensive, if the tests are not performed according to the best practice guidelines for follow-up and price.

The team highlights the importance of efficient implementation of lung cancer screening including:

  • insurer’s selection of high-quality providers

  • rigorous tracking of outcomes

  • use of best practices for managing clinical aspects of screening, especially is lesions are detected.

Pyenson explained:

“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.”

Written By Grace Rattue