title: Projected Clinical, Resource Use, and Fiscal Impacts of Implementing Low-Dose Computed Tomography Lung Cancer Screening in Medicare.
abstract: OBJECTIVE
  The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years with ≥ 30-pack-year smoking history who currently smoke or quit in the last 15 years. The clinical, resource use, and fiscal impacts of this change in screening coverage policy remain uncertain.
  
  
  METHODS
  We developed a simulation model to forecast the 5-year health outcome impacts of the CMS low-dose CT screening policy in Medicare compared with no screening. The model used data from the National Lung Screening Trial, CMS enrollment statistics and reimbursement schedules, and peer-reviewed literature. Outcomes included counts of screening examinations, patient cases of lung cancer detected, stage distribution, and total and per-enrollee per-month fiscal impact.
  
  
  RESULTS
  Over 5 years, we project that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion ($2.22 per Medicare enrollee per month). The most fiscally impactful factors were the average cost-per-screening episode, proportion of enrollees eligible for screening, and cost of treating stage I lung cancer.
  
  
  CONCLUSIONS
  Low-dose CT screening is expected to increase lung cancer diagnoses, shift stage at diagnosis toward earlier stages, and substantially increase Medicare expenditures over a 5-year time horizon. These projections can inform planning efforts by Medicare administrators, contracted health care providers, and other stakeholders.
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA jroth@fhcrc.org.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Roth
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA.
authors.forename: Bernardo H L
authors.initials: BH
authors.lastname: Goulart
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA.
authors.forename: Arliene
authors.initials: A
authors.lastname: Ravelo
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA.
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Sanderson
authors.affiliation: Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D000368:Aged; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000191:economics*; D005544:Forecasting / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006285:Health Planning; D006291:Health Policy; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D012307:Risk Factors; D012907:Smoking; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods; D014481:United States