Part II: Low-dose CT lung cancer screening – Reimbursement and the road ahead

As I discussed in my previous blog post, low-dose computed tomography (CT) screening for early lung cancer detection is still not widely practiced – despite the groundbreaking recommendation from the National Lung Screening Trial (NLST) for its use among risk groups,1 and despite support from an increasing number of major medical organizations, including the American Cancer Society (ACS).2

Today, patients pay out-of-pocket for lung cancer screening. The cost averages $169 (down from $230 last year), according to a 2013 poll conducted by the Advisory Board – a global research, technology, and consulting firm.3 Low-dose CT lung cancer screening programs have been implemented at many renowned institutions, including Boston’s Massachusetts General Hospital,4 Thomas Jefferson University Hospital in Philadelphia,5 and MD Anderson Cancer Center in Houston.6

The low level of penetration of CT lung cancer screening programs in the U.S. is due in part to spotty reimbursement from major health care payers. For example, the Centers for Medicare & Medicaid Services (CMS) does not currently pay for lung cancer screening for high-risk patients. However, there may be reason for optimism. In its July 29 draft recommendation (www.uspreventiveservicestaskforce.org/newsroom.htm), the U.S. Preventive Services Task Force (USPSTF) proposed giving CT screening a “B” grade for early lung cancer detection among high-risk patients. If the USPSTF implements this draft recommendation following a minimum 30-day public comment period, it will mean much broader coverage through private plans and could even lead to CMS coverage.

In my opinion, this recommendation reaffirms the value of early detection and the role of low-dose CT scans in saving lives. With earlier detection of this deadly disease, I hope to see a day when the 5-year lung cancer survival rate enjoys the same relatively lofty perch as cancers of the breast, prostate, and colon. When it comes to combating disease – lung cancer or otherwise – the value of knowing is undeniable; being forewarned is being forearmed.*

*Siemens Healthcare is currently indicated for low dose lung imaging. Siemens Healthcare is not indicated for low-dose lung cancer screening.

References:

1. U.S. Preventive Services Task Force (USPSTF).  http://www.uspreventiveservicestaskforce.org/bulletins/lungcandrftbulletin.pdf.

2. American Cancer Society (ACS). “Weighing the Benefits and Risks of Lung Cancer Screening.” http://www.cancer.org/cancer/news/expertvoices/post/2013/01/11/weighing-the-benefits-and-risks-of-lung-cancer-screening.aspx

3. The Advisory Board Company – Oncology Roundtable. 2013 Lung Cancer Screening Quick Poll. http://www.advisory.com/Research/Oncology-Roundtable/Resources/2012/Lung-CT-Screening-Quick-Poll-Results-Report

4. Massachusetts General Hospital. http://www.massgeneral.org/imaging/services/procedure.aspx?id=2284

5. Jefferson University Hospitals. http://www.jeffersonhospital.org/departments-and-services/lung-cancer-screening-program

6. MD Anderson Cancer Center. http://www.mdanderson.org/newsroom/news-releases/2011/ut-md-anderson-debuts-lung-cancer-screening-program.html

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