Lung cancer screening would save lives but too expensive

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The Medical Services Advisory Committee has delivered a blow to stakeholders hoping for a national lung cancer screening program.

The committee did not recommend even a limited and narrowly targeted screening program despite saying it would reduce deaths from lung cancer.

It deferred an outcome on the submission from Cancer Australia.

The organisation made the submission almost three years after former health minister Greg Hunt requested that it conduct an inquiry into the "prospects, process and delivery of a national lung cancer screening program in Australia."

The organisation conducted its own comprehensive review, including a stakeholder consultation process, leading to a final report that was delivered in October 2020.

MSAC launched its process more than a year after Cancer Australia found in favour of a national screening program to the extent that "12,000 lung cancer deaths would be prevented and between 30,000-50,000 quality-adjusted life-years would be gained."

"Further, it is estimated that over 70% of all screen-detected lung cancers would be diagnosed at an early stage compared to less than 20% of lung cancers currently detected at these early stages in Australia," it said.

In its submission to MSAC, Cancer Australia proposed a program be implemented for 'ever smokers' aged 55 and over. Those meeting 'individual risk' criteria would be sent to be scanned (low-dose computed tomography).

In its outcome, MSAC said it "accepted, with a high level of confidence, that the clinical evidence showed a significant reduction in lung cancer mortality from the proposed National Lung Cancer Screening Program."

It considered evidence that showed mortality was 2.6 lung cancer deaths per 1,000 patient-years in the screened group compared to 3.4 lung cancer deaths per 1,000 patient-years in the non-screened group. The reduction was driven by a larger proportion of cancers being detected early.

"MSAC accepted that the reduction in lung cancer mortality, offered by the Program, even without any changes in all-cause mortality was important to patients and the community," said the committee.

However, it then went on to say the program was too expensive and that the "financial model did not fully estimate the downstream implications to the Commonwealth health budget".

"MSAC advised that the overall financial impact ($157 million over 5 years) was likely underestimated and incomplete, as it included only the costs of LDCT testing and the costs of supporting the Program, but not other related downstream cost consequences such as repeat and additional testing, and treatment costs," it said.

"MSAC considered that the available evidence showed that the proposed Program would lead to a reduction in the number of deaths caused by lung cancer, but not a reduction in the total numbers of deaths taking into account other causes of death unrelated to lung cancer," said the committee in its consumer summary.

In deferring an outcome, it said, "MSAC also noted the very large cost to the government to implement the proposed Program and wanted more information so it could be more confident about how much the Program would cost overall."