title: Offering lung cancer screening to high-risk medicare beneficiaries saves lives and is cost-effective: an actuarial analysis.
abstract: BACKGROUND
  By a wide margin, lung cancer is the most significant cause of cancer death in the United States and worldwide. The incidence of lung cancer increases with age, and Medicare beneficiaries are often at increased risk. Because of its demonstrated effectiveness in reducing mortality, lung cancer screening with low-dose computed tomography (LDCT) imaging will be covered without cost-sharing starting January 1, 2015, by nongrandfathered commercial plans. Medicare is considering coverage for lung cancer screening.
  
  
  OBJECTIVE
  To estimate the cost and cost-effectiveness (ie, cost per life-year saved) of LDCT lung cancer screening of the Medicare population at high risk for lung cancer.
  
  
  METHODS
  Medicare costs, enrollment, and demographics were used for this study; they were derived from the 2012 Centers for Medicare & Medicaid Services (CMS) beneficiary files and were forecast to 2014 based on CMS and US Census Bureau projections. Standard life and health actuarial techniques were used to calculate the cost and cost-effectiveness of lung cancer screening. The cost, incidence rates, mortality rates, and other parameters chosen by the authors were taken from actual Medicare data, and the modeled screenings are consistent with Medicare processes and procedures.
  
  
  RESULTS
  Approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately 3 years. Based on our analysis, the average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. LDCT screening for lung cancer in Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years is low cost, at approximately $1 per member per month. This assumes that 50% of these patients were screened. Such screening is also highly cost-effective, at <$19,000 per life-year saved.
  
  
  CONCLUSIONS
  If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014. LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring.
authors.affiliation: Principal & Consulting Actuary, Milliman, Inc, New York.
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Pyenson
authors.affiliation: Clinical Professor, Radiology, Icahn School of Medicine at Mount Sinai.
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
authors.affiliation: Professor, Radiology, Icahn School of Medicine at Mount Sinai.
authors.forename: David F
authors.initials: DF
authors.lastname: Yankelevitz
authors.affiliation: Senior Biostatistician, Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.affiliation: Actuary, Milliman, Inc, New York.
authors.forename: Ellynne
authors.initials: E
authors.lastname: Dec