Cost Effectiveness of Lung Cancer Screening

Studies from 2010-2014 have shown that low dose CT lung cancer screening is proven cost-effective. The Milliman actuarial firm published several studies that indicate early stage lung cancer diagnosis could save over 70,000 lives a year and concluded that lung cancer screening compares favorably to other established screening exams in terms of cost-effectiveness

The Milliman Studies

Lung Cancer Alliance contracted the highly regarded international actuarial firm Milliman, Inc. to perform three cost effectiveness analyses on lung cancer screening (from 2010-2014). The studies applied actuarial mortality and payer cost analytics to the feasibility of early lung cancer detection and treatment.

Milliman I (2010)

Estimated that early stage lung cancer diagnosis could save over 70,000 lives a year. Analyzed the SEER database of over 250,000 diagnosed lung cancers with actuarial techniques and concluded that the huge mortality difference between early stage and late stage lung cancers could not be explained by lead time bias, length bias or over diagnosis.

Milliman II (2012)

Concluded that lung cancer screening compares favorably to other established screening exams in terms of cost-effectiveness. In terms of cost per life-year saved, lung cancer screening was more effective than colorectal cancer screening, breast cancer screening and cervical cancer screening, all of which are recommended by USPSTF and covered by Medicare:

• LDCT for lung cancer: $11,798 – $26,016
• Colonoscopy: $18,705 – $28,958
• Mammography: $31,309 – $51,274
• Pap Smears: $50,162 – $75,181

Milliman III (2013)

“QALY” is the most commonly used current indicator of cost-effectiveness for medical procedures. As the name suggests, the monetary analysis also includes an assessment of “quality of life.” LDCT screening in a high risk cohort of 50-64 year olds is highly cost effective at $28,240 per QALY gained. Offering smoking cessations interventions with screening improved the cost effectiveness of lung cancer screening between 20 and 45%.

Milliman IV (2014)

A fourth study specifically looked at cost and cost-effectiveness of LDCT lung cancer screening of the Medicare population at high risk for lung cancer. In 2014, there were approximately 4.9 million high-risk Medicare beneficiaries that would meet the screening criteria (beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years). The average annual cost of LDCT lung cancer screening in Medicare is estimated to be $241 per person screened. The cost of LDCT screening per Medicare member is $1 per month. This assumes that 50% of these high risk patients were screened. Such screening is also highly cost-effective at <$19,000 per life-year saved. 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.