The Effect of Positive Lung-RADS Results in a Lung Cancer Screening Program: The Beaumont Health Experience

Abstract

To evaluate the initial outcomes and cost effectiveness of who received a positive screening result and were diagnosed with lung cancer. Three thousand four hundred sixty-eight patients were screened from January 2014 to December 2016. These patients were screened on a low-dose CT screening protocol at Beaumont Health System. The ACR Lung Imaging Reporting and Data System (Lung-RADS™) were used to assign the score for each patient. Screening eligibility criteria were based on the CMS guidelines and follow up was based on Lung-RADS guidelines. Costs were calculated using patient data from internal financial systems. The expected costs quality adjusted life years (QALY) were calculated with a cost-effectiveness between $100,000 to $150,000 QALY. Six hundred twenty-four patients were categorized with a positive Lung-RADS score (3 or 4). The median age, packs per day and pack years smoked for all patients was 65, 1.0 and 40.0 years respectively. The Lung-RADS score for these patients was 55.6% (3), 22.2% (4A), and 17.1% (4BX). Lung cancer diagnosis rates for each score was 0.9% (3), 8.6% (4A) and 30.8% (4BX) with 49 lung cancers diagnosed. Median follow up was 1.2 years with 5 deaths in cohort. We found that screening for this high risk population would cost $92,132 per QALY, therefore making it cost effective. The establishment of a low-dose CT lung cancer screening program improved the ability to screen patients as demonstrated by the number of patients screened and those diagnosed with a malignancy. These findings were also consistent with the findings from the National Lung Screening Trial study and reiterates the need for a coordinated screening program.