Rates of lung cancer screening with low-dose CT (LDCT) were extremely low among eligible patients across insurance types in 2017, with rates varying between patient demographics, according to a study published in Journal of the American College of Radiology.1
LDCT screening is covered and has no out-of-pocket costs for eligible insured patients regardless of coverage type. Still, the study found that among individuals with commercial insurance, Medicare, or Medicare Advantage who were estimated to be eligible for screening in 2017, just 1.75%, 3.37%, and 4.56% got screened, respectively.
The eligibility criteria in 2017 included individuals aged 55 to 77 years who had a 30-pack-year smoking history and currently smoked or had quit within the past 15 years. In light of new evidence, those guidelines were adjusted in 2021 to include individuals aged 50 to 80 years with a 20-pack-year smoking history who currently smoke or have quit within the past 15 years.
Despite the removal of financial barriers for most insured individuals, the authors highlight several potential barriers to screening that may persist:
- the clinical challenge of identifying individuals who are eligible for screening based on history of tobacco use
- low referral rates from primary care physicians
- a lack of health insurance in patients younger than 65 years who would be eligible for screening
- a lack of LDCT facility access
- concerns about cost sharing that may arise from recalls after a positive LDCT test.
The current study used data from Optum’s de-identified Clinformatics Data Mart that included 2,204,652 commercial and 3,230,763 Medicare Advantage enrollees aged 55-77 in 2017; and data from CMS’ 5% Research Identifiable Files (RIF) that included 1,441,328 Medicare fee-for-service (FFS) enrollees in 2017.
Researchers estimated and compared LDCT screening rates between insurance types, enrollee demographics, and geographic characteristics based on 2017 United States Preventive Services Taskforce (USPSTF) eligibility criteria. Of the 6,876,743 total enrollees, the researchers estimated that 1,077,142 (15.7%) were eligible for lung cancer screening based on the 2017 USPSTF criteria.