Lung cancer exams seen as ‘good value’

Screening longtime tobacco users for lung cancer would be less costly than the widely accepted practice of screening for breast, cervical and colorectal cancers and would reduce the death toll of lung cancer by an estimated 15,000 lives a year, according to a study released this week that is likely to ignite debate on expanding health care coverage for smokers.

Using the financial standards generally employed by health insurance companies, a group of actuarial economists calculated that annual low-dose CT scans of middle-aged Americans who have smoked the equivalent of a pack of cigarettes every day for 30 years would cost each insured American an extra 76 cents a month.

That investment could give each person whose lung cancer was caught early an extra year of life, at a cost of $18,862 per patient, the economists wrote in the journal Health Affairs.

The figures put CT scanning for lung cancer on a par with colonoscopy testing for early detection of colorectal cancer, the study found. Both tests are cheaper than the mammograms and Pap tests that most health insurers pay for to screen for breast and cervical cancer.

“This screening process offers a good value for the money, and it saves lives,” said study leader Bruce Pyenson, a principal with the consulting and actuarial firm Milliman Inc. in New York.

It has been less than a year since doctors reported in the New England Journal of Medicine that annual CT scans of longtime smokers could reduce lung cancer deaths by 20 percent without causing excessive harm to patients whose readings turned out to be false positives. Those findings were based on a clinical trial involving more than 53,000 smokers that was funded by the National Cancer Institute.

Experts who weren’t involved with the Health Affairs study said the new calculations were not likely to cause insurers to change their practices – at least not yet.

Some of the assumptions used in the calculations were rosier than the results that emerged from the National Cancer Institute study, they said. For instance, they noted, the economists may have overstated the ability of CT scans to detect lung cancers early and overestimated the value of early detection in preventing lung cancer deaths.