Should Medicare pay for low-dose computed tomography to screen certain patients for lung cancer? A panel of expert advisers will meet April 30 to review the evidence and make a recommendation.
The Centers for Medicare & Medicaid Services has accepted two formal requests to initiate a national coverage analysis on lung cancer screening with low-dose computed tomography (LDCT), which the U.S. Preventative Services Task Force gave a grade B recommendation for people at high risk for lung cancer based on age and smoking history.
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CMS has accepted two requests to initiate a national coverage analysis on lung cancer screening with low-dose computed tomography.
CMS is specifically asking its Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to discuss:
• the evidence that identifies which Medicare patients would benefit the most from the screening.
• screening frequency and duration.
• provider characteristics that optimize benefits and minimize harm.
• criteria to identify a test as positive and the impact of false-positive results.
• follow-up tests or treatments.
The agency also seeks to know how these factors will impact patient education and informed consent in Medicare beneficiaries, including the elderly, younger disabled populations, and patients with end-stage renal disease, and on integrating smoking cessation interventions for current smokers.
In order for CMS to issue a national coverage determination for a preventive service, the following criteria must be met: reasonable and necessary for prevention or early detection of an illness or disability; an A- or B-grade recommendation from USPSTF; and appropriate for Medicare Part A or Medicare Part B beneficiaries.
CMS has asked the panel to vote on whether there is adequate evidence to determine if the benefits of lung cancer screening with LDCT outweigh the harms. The agency will specifically ask if there is adequate evidence to determine if LDCT improves health outcomes: in asymptomatic, high-risk adults over 74 years old; with more than three annual LDCT screens; and if the screening program is implemented outside a clinical study.
The agency is also asking for panel input on the harms of lung cancer screening with LDCT in the Medicare population, specifically harms from the scan itself (an average dose of 1.5 mSv), harms from follow-up evaluation of findings in and outside the lungs, and harms from treatment as a result of positive and false-positive results.
CMS will also ask the panel to identify and discuss any clinically significant evidence gaps regarding the use of LDCT in lung cancer screening outside of a clinical trial.
Last December, the USPSTF recommended annual screening for lung cancer with LDCT in adults aged 55- 80 years who have a 30-pack-year smoking history and currently smoke or have quit in the past 15 years. The recommendation states that screening should be stopped once a person has stopped smoking for 15 years or develops a health problem limiting life expectancy or the ability to have curative lung surgery.
The USPSTF’s recommendations were based largely on a systematic review of several randomized, controlled trials published between 2000 and 2013, including the National Lung Screening Trial. That study of more than 50,000 asymptomatic adults, aged 55-74 years, showed a 16% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality when patients were screened using LDCT. One cancer death was averted for every 320 patients screened, and one death from all causes was prevented in every 219 patients screened.
Under the Affordable Care Act, insurers are required to cover, with no copay requirements, preventative care and screening services that receive a grade A or grade B recommendation from USPSTF.