Establishing a new technique or method that both is beneficial to a patient population and reduces costs to health care providers is rare, but that is precisely what a new cost-benefit analysis conducted by Milliman Inc shows. The recent study looks at the use of low-dose CT for screening a patient base at high risk for developing lung cancer—specifically, lifetime smokers.
Gail Rodriguez, Executive Director, MITA
“The most important thing is that it demonstrates a 20% reduction in mortality,” said Gail Rodriguez, executive director of the Medical Imaging & Technology Alliance (MITA). “That is dramatic. That’s the holy grail: mortality. The next message is that it’s going to be cost-effective as well. The assumption that you take a really big study like this and you can derive not only clinical benefits but also an economic benefit to using this modality is earth shattering.”
The randomized study examined the costs and benefits of providing lung cancer screening through low-dose CT to commercially insured high-risk individuals; specifically, for smokers and long-term former smokers ages 50 to 64. At current reimbursement rates, the CT screening would cost approximately one dollar per insured member per month. The study also estimates that the cost per life-year saved would be below $19,000, an amount lower than screening for cervical and breast cancer and comparable to the cost per life-year saved of screening for colorectal cancer.
However, this extra screening also carries dose concerns for patients, something that is not lost on proponents of the procedure.
“There’s an awful lot of concern among all medical stakeholders about dose,” Rodriguez said. “As with any study, you have to weigh the risks and benefits. In these high-risk folks, the benefits outweighed the risks. In a low-risk population, we can’t say that. This was only done in this population; I think they were all over 50 and all had a long history of smoking. We always have to weigh the benefits and the risks of ionizing radiation. Here, the benefits outweigh the risks.”
As with all new procedures, however, there is still a major hurdle to its implementation: coverage and reimbursement. Given the dose concerns and the effect this may have on utilization rates, advocates may run into opposition for coverage, but with the backing of major cancer and imaging associations—MITA, the American College of Radiology, and the National Comprehensive Cancer Network, among others—and quality studies proving its effectiveness, this technique may eventually become common practice for high-risk populations. Until then, given the cost benefits of the procedure, private insurance companies may be more willing to offer coverage.
“This is good data,” Rodriguez said. “Someone will need to submit for a Medicare coverage decision. That wouldn’t be us—MITA. At some point, when there are sufficient data to go for a national coverage decision, I’m sure they will. I’m not sure exactly where they are in that decision-making process. The national coverage decision is a big deal. CMS wants evidence and this is a really good study.
“Medicare is not allowed to use any cost-effectiveness or cost utility data in its coverage decisions, but the private carriers do. That might be why they seem more willing on the front end.”
