Dartmouth researchers say lung cancer computed tomographic (CT) screening in the National Lung Screening Trial (NLST) meets a commonly accepted standard for cost-effectiveness as reported recently in The New England Journal of Medicine.1 The 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 to 75 years of age,” said William C. Black, MD, Chair of the Lung Cancer Screening Group at Dartmouth-Hitchcock Medical Center and Professor of Radiology, of Community & Family Medicine, and of The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
The Dartmouth study found that screening costs $81,000 for each quality-adjusted year of life (QALY) it produces. For policymakers, this ratio establishes relative worth from an economic perspective. A proposed benchmark for cost-effectiveness is $100,000 to $150,000 QALY.
“I think the vast majority of health economists would consider the threshold to be close to $100,000 per QALY,” said Dr. Black.
Screening Is More Cost-Effective in Some Subgroups
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 60s. “Although precision with subsets is not as good as overall, people at higher risk seemed to benefit more from screening, so, for example, current smokers benefited much more than people who had quit,” said Dr. Black.
Lung cancer screening is not yet standard medical practice. Over the past 2 years, multiple professional associations have issued statements that recommend physicians offer annual lung cancer CT screening to individuals 55 to 80 years old who have more than a 30–pack-year history of smoking.
In this study Dartmouth researchers evaluated more than 53,000 participants in the 7-year NLST. For each 1,000 people screened there were about three fewer deaths from lung cancer. NLST followed strict protocols and the results of this study do not necessarily apply to lung cancer screening programs implemented differently.
Since the NLST was conducted, the American College of Radiology (ACR) narrowed its definitions of a “positive” lung cancer screening test to help reduce the risk of false-positive results. “The new ACR LungRADs reporting system should reduce the false-positive rate by about 50%,” said Dr. Black, “and reduce the cost-effectiveness ratio by several thousand dollars per QALY gained.” ■
Editor’s note: On November 11, 2014, the Centers for Medicare & Medicaid Services (CMS) announced its proposed decision that there is sufficient evidence to cover lung cancer screening with low-dose CT screening for individuals at high risk for lung cancer.
Disclaimer: The study was funded by the National Cancer Institute; the National Lung Screening Trial ClinicalTrials.gov number is NCT00047385.
1. Black WC, Gareen IF, Soneji SS, et al: Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 371:1793-1802, 2014.