THE BLOG
09/03/2014 12:45 pm ET Updated Nov 03, 2014

Advocates Jump Final Hurdle for Lung Cancer Screening Coverage

Right now, the Centers for Medicare and Medicaid Services (CMS) are deliberating whether or not they will offer high-risk Medicare beneficiaries access to lifesaving lung cancer screening. Despite the overwhelming evidence that lung cancer screening could save tens of thousands of lives, some maintain that Medicare coverage would simply be too costly.

But a study published just last Friday in the August issue of American Health and Drug Benefits, conducted by Milliman, Inc., helps advocates clear the final coverage hurdle, proving the cost-effectiveness of the early detection of lung cancer in high-risk Medicare beneficiaries.

The Milliman study found that screening those at risk in the Medicare population would add only $1 to the average monthly beneficiary cost. Compare that to screening for breast and colorectal cancers, which are already covered by Medicare and cost an additional $2.50 and $1.40, respectively.

Another yard stick health policymakers have used to measure a medical procedure's value is the "cost per life-year saved" calculation, which Milliman also analyzed in two separate studies. For lung cancer screening, the cost per life-year saved calculation was under $19,000. Whereas the cost per life-year saved figure for breast cancer ranges from $31,309 to $51,274, and for colonoscopy $18,705 to $28,958.

Put simply, the argument that covering lung cancer screening would simply be too costly for Medicare to cover is unfounded. Lung cancer screening is clearly cost-effective -- not to mention lifesaving.

Lung cancer is the leading cancer killer in the United States, claiming more than 150,000 lives annually, more than breast, prostate and colon cancers combined.

One of largest (53,000 people at high risk for lung cancer) and most expensive ($250,000,000) cancer screening trials in National Cancer Institute's history, carried out from 2002 to 2010, showed that just three rounds of computed tomography (CT) screening reduced lung cancer mortality rates by 20 percent -- an extraordinary percentage that subsequent studies indicate may prove to be two or three times greater with more screening rounds, and with the more advanced technology and protocols in use today.

Diagnosing lung cancer early will change this disease from a primarily deadly one to a curable one.

It is with this in mind that the United States Preventive Services Task Force (USPSTF) -- the federal agency that develops recommendations for clinical preventive services -- recommended annual lung cancer screening for high-risk individuals. With this level of recommendation, lung cancer screening is now considered an "essential health benefit," meaning it must be covered - without a co-payment requirement -- by private insurance companies for the under-65, high-risk population.

For CMS to close the door on this coverage when a person turns 65 would make no sense, especially considering that the majority of lung cancer cases are currently being diagnosed in people over the age of 65. We can save lives in a cost-effective manner with lung cancer screening, which allows lung cancer to be detected at the disease's earliest, most curable stages, when the treatment is less complicated and the costs are lower.

Given the proven cost effectiveness and lifesaving value of lung cancer screening, coverage should be a slam dunk for Medicare -- one would think...