NLST Data Reveals CT Lung Cancer Screening Could Be Cost Effective

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As the U.S. Preventative Services Task Force (USPSTF) weighs guidelines and uniform reimbursement policies regarding the use of low-dose CT scans for lung cancer screening, the question of whether the test is cost effective is the elephant in the room. While no one wants to put a price on life, the issue of how to keep health care costs from climbing to unsustainable levels is inescapable. The best case scenario is for a test to be proven helpful to patients and cost effective at the same time. According to additional National Lung Cancer Screening Trial (NLST) data brought up at the first joint meeting of the National Cancer Advisory Board and the National Institutes of Health (NIH) National Cancer Institute Board of Scientific Advisors, this just may be the case for CT lung cancer screening. The data and the fact that CT lung cancer screening is being debated at such high-level meetings adds pressure on the American College of Radiology to issue its own guidelines and best practices for how the test should be performed. Like all imaging tests, if CT lung cancer screening is used inappropriately, the test could quickly become a health care cost driver rather than a cost saver. Not to mention that it could expose patients who didn’t need to the test to unnecessary radiation. In a written statement the ACR said that it looked forward to the NLST cost effectiveness analysis results, and cited additional research evidence like this as just one of the very good reasons it has not yet issued its own set of instructions to members on use of the exam. “The ACR will use this new information in the ongoing creation of guidelines for CT lung cancer screening for spring 2014, the development of appropriateness criteria, and to address staffing and care models needed to support widespread screening guidelines,” the statement read. “This timetable allows for careful consideration of current and emerging studies in peer-reviewed medical literature, including the cost-effectiveness analysis from the National Lung Screening Trial.” While waiting for the ACR’s own guidelines and appropriateness criteria to be finalized, members should follow the National Comprehensive Cancer Network (NCCN) guidelines for lung cancer screening, the College advised. One of the patient advocacy groups that has encouraged creation of uniform national standards around lung cancer screening is the Lung Cancer Alliance (LCA). Laurie Fenton Ambrose, its president and CEO, said that she and her colleagues at the LCA were “thrilled” to hear of the additional cost effectiveness data. “We hope this encourages the ACR to reconsider its timetable and accelerate its timeline,” she said. “We are going to keep working with them on an accelerated time frame.”