Lung Cancer Screening Could Cost Medicare Billions

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Every person covered by Medicare would shell out an additional $3 a month if the government agreed to pay to screen certain current and former smokers for lung cancer, a new study estimates.

It would cost Medicare $2 billion a year to follow recent advice to offer these lung scans – and fuel angst about rising health costs that are borne by everyone, not just smokers, the study found.

Joshua Roth of the Fred Hutchinson Cancer Research Center in Seattle said the researchers merely were tallying the cost of screening, and were not “judging value” or saying whether Medicare should pay it. He led the study, which was released Wednesday and will be presented at an American Society of Clinical Oncology conference later this month.

Lung cancer is the world’s top cancer killer, mainly because it’s usually found too late for treatment to do much good. Most deaths involve Medicare-age people, and most are due to smoking.

Recently, a major study found that annual CT scans, a type of X-ray, could cut the chances of dying from lung cancer by up to 20 percent in those most at risk – people ages 55 through 79 who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years.

Based largely on that, the U.S. Preventive Services Task Force in December recommended screening that group, about 10 million Americans. The scans cost $100 to as much as $400. Under the new health care law, cancer screenings recommended by the task force are to be covered with no copays.

However, Medicare makes its own coverage decisions and is to announce one by November. The new study sought to peg the fiscal impact and inform the debate.

Researchers took into account the fact more people would get treatment for earlier-stage cancers, yet the costs of late-stage treatment and end-of-life care would be reduced. They estimate that over five years, Medicare-covered screening would lead to:

-11.2 million more lung scans, including 2 million false alarms.

-54,900 more lung cancer cases detected.

-32 percent of lung cancers being found at an early stage versus 15 percent now.

-$9.3 billion in new costs: $5.6 billion for scans, $1.1 billion for biopsies and other tests, and $2.6 billion more for cancer treatments.

-$3 more per month on Medicare premiums.

The cancer drug company Genentech paid for the study.

Independent experts praised the researchers but said more needs to be known about screening’s benefits.

“The interesting question is what that three extra dollars per month buys you” in terms of extra healthy years of life, said Dr. Harold Sox, a Dartmouth professor and former chairman of the government task force.

The cost “seems like a pretty good use of resources” compared to many other things Medicare pays for, said Dr. Peter Bach, a health policy expert at Memorial Sloan Kettering Cancer Center in New York and a former adviser to Medicare. Bach has petitioned Medicare to cover the lung scans.

“I wasn’t particularly disturbed by the price tag. This is potentially an inroad into preventing a lot of cancer deaths,” he said.

People may not understand the true costs of any type of cancer screening, which sometimes leads to unnecessary biopsies, follow-up tests and even treatment of a certain number of cancers that would never have proved life-threatening.

A previous study of people in an insurance plan – not Medicare – estimated breast cancer screening with mammograms added $2.50 to the cost of monthly premiums and colorectal screening, 95 cents per month.

 

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