title: An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost.
abstract: Lung cancer screening is not established as a public health practice, yet the results of a recent large randomized controlled trial showed that screening with low-dose spiral computed tomography reduces lung cancer mortality. Using actuarial models, this study estimated the costs and benefits of annual lung cancer screening offered as a commercial insurance benefit in the high-risk US population ages 50-64. Assuming current commercial reimbursement rates for treatment, we found that screening would cost about $1 per insured member per month in 2012 dollars. The cost per life-year saved would be below $19,000, an amount that compares favorably with screening for cervical, breast, and colorectal cancers. Our results suggest that commercial insurers should consider lung cancer screening of high-risk individuals to be high-value coverage and provide it as a benefit to people who are at least fifty years old and have a smoking history of thirty pack-years or more. We also believe that payers and patients should demand screening from high-quality, low-cost providers, thus helping set an example of efficient system innovation.
authors.affiliation: Milliman, New York City, New York, USA. bruce.pyenson@milliman.com
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Pyenson
authors.forename: Marcia S
authors.initials: MS
authors.lastname: Sander
authors.forename: Yiding
authors.initials: Y
authors.lastname: Jiang
authors.forename: Howard
authors.initials: H
authors.lastname: Kahn
authors.forename: James L
authors.initials: JL
authors.lastname: Mulshine
mesh_terms: D000206:Actuarial Analysis; D017046:Cost Savings; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D008175:Lung Neoplasms / Q000175:diagnosis*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States