Wednesday, November 12, 2014

CMS Releases Proposed NCD for Lung Cancer Screening

On November 10, 2014, CMS released a proposed NCD that covers annual low-dose CT lung cancer screening for beneficiaries with a long smoking history.

For detailed coverage of the public advisory panel held at CMS last spring, see here.

The topic was controversial because the screening test received a "B" rating earlier from the USPSTF, and the Affordable Care Act requires coverage for individuals with commercial health insurance.   Medicare law allows coverage under Medicare, but requires a separate review and National Coverage Determination, the process that is underway.

In my reading, the topic was controversial because while the pivotal trial was very, very large (about 50,000 patients), the absolute survival benefit was very small (about 0.4%), suggesting that if implementation was a little bit less effective than the trial, there wouldn' t be a benefit.  This is almost always the case with very large trials; if you study an anti-platelet drug in 30,000 patients, it's because the benefit of the drug is likely in the 1% range.

CMS proposes to require that all beneficiaries covered for low dose CT screening have a standardized, multi-faceted training and awareness counseling session, and that each eligible center must participate in a nationwide Medicare registry.  

The national coverage decision is online here.   Coverage at the radiology/imaging industry website AuntMinnie is here (free registration required).  New England Journal ran an article on cost-effectiveness a few weeks ago, here.  JAMA Internal Medicine ran recent articles on the topic, here ("Overdiagnosis in CT screening") and here ("CT Screening, How strong is the evidence?")  JAMA Internal Medicine is edited by Dr. Rita Redberg (here) who also is chairperson of the federal advisory committee MedCAC (here).

Coverage at NY Times here; at Medscape here.  At "Radiology Business," here.

A blog at Health Affairs by Dora Hughes MD, here.

Some interesting parallels between this NCD and some recent LCDs on molecular diagnostics will be discussed in a future post.