CMS wants evidence before deciding on coverage for lung cancer screening

The Centers for Medicare & Medicaid Services has published the topics it expects to be discussed during the April 30 Medicare Evidence Development Coverage Advisory Committee meeting (MEDCAC) meeting looking at whether low-dose CT lung cancer screening should be covered by Medicare.

CMS is particularly interested in evidence that can help identify those Medicare patients eligible to be screened; how often and for how long they should be screened; the characteristics of providers and facilities that might optimize benefits and minimize the harms of screening; and the precise criteria that can be used to identify a test as positive, the impact of false positive results and follow up tests or treatments.

The U.S. Preventive Services Task Force in December issued a final recommendation that individuals at a high risk of lung cancer--those adults ages 55 to 80 years who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years--undergo annual low-dose lung CT screening.

The following are questions on which MEDCAC will vote:

  • How confident are you that there is adequate evidence to determine if the benefits outweigh the harms of lung cancer screening with LDCT [CT acquisition variables set to reduce exposure to an average effective dose of 1.5 mSv (please see footnotes)] in the Medicare population?
  • How confident are you that there is adequate evidence to determine that screening in asymptomatic high risk adults over 74 years of age improves health outcomes? (CMS pointed out that the USPSTF recommendation is based largely on the results of the National Lung Screening Trial, which enrolled patients who were between the ages of 55 and 74.)
  • How confident are you that there is adequate evidence to determine that annual screening beyond three annual LDCT screens improves health outcomes?
  • How confident are you that there is adequate evidence to determine that a lung cancer screening program implemented outside a clinical study improves health outcomes?
  • How confident are you that the harms of lung cancer screening with LDCT (average effective dose of 1.5 mSv), if implemented in the Medicare population, will be minimized?
  • How confident are you that clinically significant evidence gaps remain regarding the use of LDCT (average effective dose of 1.5mSv) for lung cancer screening in the Medicare population outside a clinical trial?

To learn more:
- read the CMS information about the MEDCAC meeting

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