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diagnostic procedures among adults with positive LDCT who were ultimately determined not to have lung cancer was 2.7%,12 according to NLST results. Thus, although LDCT demonstrates a high false-positive risk, the risk of biopsy
or other invasive diagnostic procedure following a false positive screening test is low.11
The cost-effectiveness of population- based LDCT is demonstrated in literature. The average cost of LDCT screening among the Medicare population is estimated to be $241 per person screened.15 If 50% of eligible Medicare
of LDCT screening spread across the Medicare population translates into
$1.02 per member per month (PMPM), assuming no cost sharing for screening or required smoking cessation session.15 The PMPM cost of LDCT screening among the Medicare population is lower than the PMPM cost for breast-cancer screening mammography ($2.50 PMPM).15 In
the Pan-Canadian Early Detection of
Lung Cancer Study, the average cost of LDCT screening and resulting curative surgery among high-risk individuals was $33,344, 30.2% lower than the average cost of treating advanced-stage lung cancer with chemotherapy, radiation, or supportive care ($47,792).16 Researchers recently measured the cost-effectiveness of 576 LDCT screening scenarios in which these eligibility variables were adjusted: age to start screening, age
to stop screening, screening interval, pack years, minimum number of years smoked, minimum number of cigarettes smoked per day, maximum number of years since smoking cessation to be from further screening after reaching the maximum number of years since smoking cessation.17 The most cost-effective population-based LDCT screening scenario involved annual screening between ages 55-75 for individuals
who smoked > 40 pack years and who currently smoke or quit < 10 years ago.17 Thus, lung cancer screening with LDCT is most cost-effective in population-based
settings when screening eligibility is restricted to individuals at highest risk. As Delaware expands its LDCT screening current and former smokers can identify priority subpopulations at highest risk
for lung cancer. LDCT screening is most cost-effective for these patients.
LDCT LUNG CANCER SCREENING IS A PUBLIC HEALTH PRIORITY
As of 2015, Medicare covers the cost
of annual lung cancer screening with LDCT for eligible adults.18 Under
Section 2713 of the Affordable Care Act, private health plans must cover annual lung cancer screening with LDCT for eligible adults aged 55-80 and may not impose cost sharing through copayments, deductibles, or co-insurance.19 Despite its effectiveness in decreasing lung cancer and all-cause mortality, its demonstrated cost-effectiveness in population-based settings, its ability to detect additional chronic conditions, and its coverage by most private and public insurance options, the medical community has been hesitant to champion LDCT as an important tool to reduce lung cancer morbidity and mortality in Delaware. Among patients eligible for LDCT, the rate of receiving
an LDCT order increased from 0% in 2010-2011 to 7.3% in 2016.20 Whereas both the public health and medical communities have widely championed early-detection initiatives for breast, cervical, colorectal, and prostate cancers, the provider community has not embraced LDCT to a similar extent. Pyenson and Tomicki (2018) describe the pace of LDCT uptake by the medical community as “frustratingly slow.”21
A frequently cited concern about LDCT is that current smokers who undergo screening and receive normal results may be less likely to quit smoking. However, a systematic review by the American
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Del Med J | September/October 2019 | Vol. 91 | No. 5
