CMS should not pay for regular CT screenings for heavy smokers, panel says

A Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The CMS' nine-member Medicare Evidence Development and Coverage Advisory Committee voted Wednesday against paying for the screening tool.

The unexpected decision on the nonbinding recommendation runs counter to a December 2013 recommendation by the U.S. Preventive Services Task Force that current or past heavy smokers ages 55 to 80 should get the scans. Under the Patient Protection and Affordable Care Act, the task force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members. The test typically costs $300 to $400.

The members of the Medicare committee, which advises CMS on coverage determinations, indicated that they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The task force made the decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

While the panel members, most of them clinicians, agreed that the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.

“We've never relied on a single trial when creating national policy,” said Dr. Steven Woolf, director of the Center on Society and Health at Virginia Commonwealth University. “If you look at the data, I'm not understanding where we're getting substantial benefit.”

Dr. Rita Redberg, chair of the Medicare committee and professor of medicine at the UCSF School of Medicine, emphasized that the importance of making the right decision because of the confusion that arises among physicians and the public when recommendations change. She noted, for example, the conclusions that routine mammograms for women under 50 and routine prostate-specific antigen tests for men do more harm than good. “It's important for us to have good confidence in the evidence,” she said.

Patient advocates are hopeful that the CMS will not agree with the advisory committee. “This is a nonbinding poll by a group of committee members outside of lung cancer screening on their understanding of the level of existing evidence and data existing,” said Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance.

The CMS expects to release a proposed decision memo in November and a final national coverage determination by February 2015.

Smoking-related lung cancer kills about 130,000 Americans each year. The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease. The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.

Correction: An earlier version of this story mischaracterized comments made by Dr. Rita Redberg.

Follow Virgil Dickson on Twitter: @MHvdickson