• Joshua A Roth, Sean D Sullivan, Bernardo H L Goulart, Arliene Ravelo, Joanna C Sanderson, and Scott D Ramsey.
• Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA jroth@fhcrc.org.
• J Oncol Pract. 2015 Jul 1; 11 (4): 267-72.

PurposeThe Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years with ≥ 30-pack-year smoking history who currently smoke or quit in the last 15 years. The clinical, resource use, and fiscal impacts of this change in screening coverage policy remain uncertain.MethodsWe developed a simulation model to forecast the 5-year health outcome impacts of the CMS low-dose CT screening policy in Medicare compared with no screening. The model used data from the National Lung Screening Trial, CMS enrollment statistics and reimbursement schedules, and peer-reviewed literature. Outcomes included counts of screening examinations, patient cases of lung cancer detected, stage distribution, and total and per-enrollee per-month fiscal impact.ResultsOver 5 years, we project that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion ($2.22 per Medicare enrollee per month). The most fiscally impactful factors were the average cost-per-screening episode, proportion of enrollees eligible for screening, and cost of treating stage I lung cancer.ConclusionLow-dose CT screening is expected to increase lung cancer diagnoses, shift stage at diagnosis toward earlier stages, and substantially increase Medicare expenditures over a 5-year time horizon. These projections can inform planning efforts by Medicare administrators, contracted health care providers, and other stakeholders.Copyright © 2015 by American Society of Clinical Oncology.

30 keywords...

hide…