Lung-cancer screening via CT -- again, the cost-effectiveness issue

Screening heavy smokers for lung cancer does reduce deaths, without leading to too many dangerous follow-up tests, and researchers now have the numbers to prove it. That question would appear to be settled. But the cash to implement such a program … now that’s another issue entirely.

The analysis validating lung-cancer screening via spiral CT scans comes from a trial of more than 53,000 patients. Researchers found that giving smokers and ex-smokers chest CT scans could reduce lung cancer deaths by 20%. In another way of interpreting the data, 320 smokers and ex-smokers needed to be screened to prevent one death. The full story is in this Los Angeles Times article.

For many diseases, screening is often deemed “not worth it” in part because of the harm done to people who test positive but don’t have the disease (false positives).

But as the article notes: “The researchers found that even though the scans produced many false-positive results — affecting 39% of those who were screened three times — there were few serious complications resulting from them.”


It goes on: “The primary questions now … are how much widespread screening will cost and what effect it will have on other medical resources. Medicare now pays about $300 for a CT scan, but further testing resulting from a positive finding will cost many times that amount.”

And that is the question of the day (or decade).

In a report released, with no timing irony intended, on the same day that the above study was published, the Organisation for Economic Co-operation and Development noted that the U.S. spent nearly $8,000 per capita on healthcare in 2009, the most by far of industrialized countries.

Here’s how America’s standing is summed up:

“As a share of GDP, the United States spent 17.4% on health in 2009, five percentage points more than in the next two countries, the Netherlands and France (which allocated 12.0% and 11.8% of their GDP on health). Norway and Switzerland were the next biggest spenders on health per capita, with spending of more than $5,000 per capita in 2009.”

Screening is one of the many ways the U.S. hits such lofty numbers.

As the Health Blog from the Wall Street Journal states, fairly bluntly:

“At this point, we know that screening and follow-up can be expensive, and with a limited pot of money, resources might be better spent on smoking cessation programs. “


And that might cut down, not only, on lung cancer, but a long list of health ills, including coronary heart disease, emphysema, bronchitis and stroke.

That would save money too.

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