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Low-dose computed tomography lung cancer screening in the Medicare program: Projected clinical, resource, and budget impact.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: Based on evidence from the National Lung Cancer Screening Trial (NLST), the U.S. Preventive Services Task Force (USPSTF) recently recommended annual low dose computed tomography (LDCT) lung cancer screening in patients age 55-80 with a 30 pack-year smoking history who currently smoke or quit in the past 15 years. Under the terms of the Affordable Care Act, Medicare will cover this screening procedure. We project the clinical, resource, and budget impact of this policy. Methods: We developed a model to forecast the 5-year incremental outcomes of implementing USPSTF LDCT screening recommendations vs. no screening. The model simulates a Medicare cohort consistent with 2013 enrollment and age distribution statistics. Lung cancer detection rates and stage at diagnosis were derived from the NLST. Included costs were LDCT screening/follow up, confirmatory bronchoscopy/biopsy, and stage specific lung cancer treatment (initial, continuing, terminal care). We estimated lung cancers detected, LDCT scans, and the total and per member per month (PMPM) budget impact in two scenarios: 1) complete implementation, with all eligible patients offered screening in all years, and 2) phased implementation, with an additional 20% of eligible patients offered screening each year. Results: In the complete and phased implementation scenarios, screening resulted in 141,000 and 101,000 more lung cancers detected (mostly Stage I), 37.5 million and 22.4 million more LDCT scans, and increased overall expenditure of $27.4 billion (PMPM $8.80) and $17.6 billion (PMPM $5.70), respectively. The most influential inputs were the proportion of eligible patients electing to undergo screening, initial treatment cost of early-stage lung cancer, and the proportion of stage IV diagnoses in the no screening strategy. Conclusions: Our analyses suggest that LDCT screening is will increase lung cancer diagnoses, result in a greater proportion of cases diagnosed at an early stage, and substantially increase Medicare expenditure. Forthcoming analyses will evaluate the resource demands of complete and phased screening implementation relative to existing LDCT facility and health professional supply.
Abstracts by Joshua A. Roth:
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