Aug 18, 2003
Physician-scientists at NewYork-Presbyterian Hospital and Weill Cornell Medical College have shown that low-dose computed tomography (CT) screening for lung cancer may not only improve a lung cancer patient's chances for a cure, but is also likely to be cost-effective when compared with other widely accepted cancer screening methods. Published in the August Chest, the analysis demonstrates that annual low-dose CT screening for lung cancer compares quite favorably to cost-effectiveness ratios of other screenings.
The study—a collaboration between NewYork Weill Cornell Medical Center, Mount Sinai School of Medicine, and Columbia University Graduate School of Business—finds that the yearly cost of saving one life using a single low-dose CT scan could be as low as $2,500. The analysis is based on data from the Early Lung Cancer Action Project (ELCAP) study, which analyzed the response of low-dose CT screening for 1,000 high-risk individuals. The current study's estimation of cost effectiveness is the first to employ detailed data from an actual screening study, unlike previous cost effectiveness studies that relied upon assumptions and hypothetical models.
CT screening for lung cancer may be significantly more cost effective than annual PAP smear for cervical cancer screening, which costs approximately $50,000 per life-year saved, or annual mammography, which costs about $24,000 per life-year saved—two well-accepted early detection strategies to decrease cancer mortality.
"With CT screening, more than 80 percent of lung cancers are diagnosed in the earliest, most curable stage. Without CT screening, less than 15 percent of cancers are in this early stage," said Dr. Claudia Henschke, the study's Principal Investigator, Professor of Radiology at Weill Cornell Medical College, and Chief of the Chest Imaging Division at NewYork Weill Cornell Medical Center. "Lung cancer screening is cost-effective because the CT and further work-up cost is low, the frequency of finding early stage curable cancer by screening is high, and the cost of surgery is less than half of the cost of late-stage treatment. There is no medical or economic reason for high-risk individuals not to be screened."
"The good news is that low-dose CT scans have the potential to be within the range of practice and policy acceptability," added Dr. Alvin Mushlin, the study's co-author and Professor and Chairman of the Department of Public Health at Weill Cornell Medical College. "Furthermore, as the screening becomes more widely available, the price—and consequently, the cost-effectiveness ratio—should continue to become even more favorable."
Additionally, the study found that the cost-effectiveness of CT screening is further improved by the identification of high-risk individuals (based on smoking history, history of asbestos exposure, and emphysema). It follows that cost effectiveness will further improve as methods to identify at-high-risk individuals advance, such as with genetic markers.
The original ELCAP study, which was led by Dr. Henschke and published in the July 1999 Lancet, determined that low-dose CT scans found more than 80 percent of the screening-detected cancers to be of Stage I, the most curable stage of the cancer.
The study made use of financial data on all procedures performed on the participants—including the cost of a low-dose CT screening, follow-up CTs, and fine needle aspiration (FNA)—based on actual costs incurred by ELCAP volunteers, as recorded and determined by NewYork-Presbyterian Hospital.