CT lung cancer screening for high-risk individuals in the Medicare program received a vote of low confidence by a panel of medical experts meeting in Baltimore today. The vote seriously weakens the case for establishing Medicare payment for low-dose CT lung cancer screening.
The U.S. Centers for Medicare and Medicaid Services (CMS) convened the meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to review the evidence behind CT lung cancer screening. The low-confidence vote came despite solid evidence from the National Lung Screening Trial (NLST) and substantial ongoing research showing that screening of high-risk individuals with CT yielded a 20% mortality gain compared to chest x-ray screening.
While a small army of clinicians and other advocates spoke in favor of screening at today's meeting, the MEDCAC panelists raised questions about everything from mortality reductions to cost to a lack of standardized CT lung screening protocols. The panelists expressed their lack of confidence in the benefits of screening through answers to three questions, graded on a five-point scale in which 5 represented the highest level of confidence in the question and several subquestions.
Scores were as follows:
- How confident are you that there is adequate evidence to determine if the benefits outweigh the harms of lung cancer screening with low-dose CT? Mean score of 2.2222.
- How confident are you that the harms of lung cancer screening with low-dose CT if implemented in the Medicare population will be minimized? Mean score of 2.3333.
- How confident are you that clinically significant evidence gaps remain regarding the use of low-dose CT for lung cancer screening in the Medicare population outside a clinical trial? Mean score of 4.4444.
MEDCAC will publish its formal recommendations to CMS in November concurrently with a second public comment period to discuss its recommendations.
