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New Study Supports the Inclusion of Low Dose CT Scans for High Risk Populations in Clinical Recommendations

Washington, D.C. – A new study, A Cost-Utility Analysis of Lung Cancer Screening and the Additional Benefits of Incorporating Smoking Cessation Interventions, supported by Legacy® and The Lung Cancer Alliance was just published in PLOS ONE.  The study, performed by Milliman actuaries led by Bruce Pyenson and researchers at Legacy’s Schroeder Institute for Tobacco Research and Policy Studies determined that Low-Dose Computed Tomography (LDCT) screenings for lung cancer are highly cost-effective in a commercially insured population of adults aged 50-64 at high risk for lung cancer. Lung cancer is the nation's number one cancer killer of both men and women, accounting for about 28 percent of all cancer deaths. Lung cancer kills more Americans than breast cancer, prostate cancer and colon cancer combined. Up to 90 percent of lung cancer cases can be attributed to tobacco use.  There is no current treatment to cure late stage lung cancer. Screening with CT scans is the only method that has been validated as a way to reduce lung cancer deaths through early detection. These data build on the landmark findings from the National Lung Screening Trial showing a 20 percent reduction in lung cancer mortality among high risk adults receiving LDCT scans rather than chest X-rays for lung cancer.

A key question in the field of medicine is how to capitalize on clinical encounters to maximize the impact of preventive services. This study also quantified the additional benefits of incorporating smoking cessation interventions of varying intensity in an annual lung cancer screening program. Offering smoking cessation interventions with the annual screening program further improved the cost-effectiveness of lung cancer screenings by 20-45 percent. 

The study examined repeated LDCT screenings over a period of 15 years in a high risk hypothetical cohort of 18 million adults between the ages of 50 and 64, each with a 30+ pack-years of smoking history. The expected cost of screening and diagnosis was $0.76 per-member-per-month.  When compared to the same hypothetical cohort with no screenings, the results found that the screenings were highly cost-effective, saving almost 1 million quality-adjusted life years (QALYs) and costing commercial insurers$27.8 billion over 15 years for screening, diagnosis and treatment, for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings increased the cost of the program while also increasing the QALYs gained in this high risk population. These benefits resulted in more favorable cost-utility ratios ranging from $16,198 to $23,185 per QALY gained for LDCT and smoking cessation interventions combined.

The cost-utility ratios estimated in this study were well in line with other accepted cancer screening interventions, including breast, cervical and colorectal cancer screenings, and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.

"This study validates that lung cancer screening is cost-effective to commercial payers who insure adults in the U.S. workforce" said Cheryl G. Healton, DrPH, president and CEO of Legacy. “We need to move forward aggressively to ensure that high quality lung cancer screening for high risk populations is embedded into clinical guidelines and the public health infrastructure so that fewer lives are needlessly lost to lung cancer.”

Lung Cancer Alliance President and CEO Laurie Fenton, said this actuarial analysis of the cost effectiveness of lung cancer screening reinforces the draft recommendation and evidence review issued by the U.S. Preventive Services Task Force last week which gave CT screening those at high risk for lung cancer its second highest level of endorsement.

The study can be found online: