Targeted Incentive Programs For Lung Cancer Screening Can Improve Population Health And Economic Efficiency

Abstract

Because an intervention's clinical benefit depends on who receives it, a key to improving the efficiency of lung cancer screening with low-dose computed tomography (LDCT) is to incentivize its use among the current or former smokers who are most likely to benefit from it. Despite its clinical advantages and cost-effectiveness, only 3.9 percent of the eligible population underwent LDCT screening in 2015. Using individual lung cancer mortality risk, we developed a policy simulation model to explore the potential impact of implementing risk-targeted incentive programs, compared to either implementing untargeted incentive programs or doing nothing. We found that compared to the status quo, an untargeted incentive program that increased overall LDCT screening from 3,900 (baseline) to 10,000 per 100,000 eligible people would save 12,300 life-years and accrue a net monetary benefit (NMB) of $771 million over a lifetime horizon. Increasing screening by the same amount but targeting higher-risk people would yield an additional 2,470-6,600 life-years and an additional $210-$560 million NMB, depending on the extent of the risk-targeting. Risk-targeted incentive programs could include provider-level bonuses, health plan premium subsidies, and smoking cessation programs to maximize their impact. As clinical medicine becomes more personalized, targeting and incentivizing higher-risk people will help enhance population health and economic efficiency.

Exhibit 2. Life-years gained per 100,000 eligible adults screened by low-dose computed tomography (LDCT) instead of chest x-ray, by risk of lung cancer death

Source/Notes: SOURCE Authors’ analysis. NOTES The average is for all risk groups (explained in the text). In 2015, 6.82 million US adults were eligible for annual LDCT screening, as explained in the text. Whiskers indicate 95% confidence intervals. The interval bounds correspond to the people in a group at the 2.5 and 97.5 percentiles. For example, for people in the highest risk group over a lifetime horizon, the person at the 2.5 percentile gains 0.032 life-years (3,200 life-years per 100,000 people), whereas the person at the 97.5 percentile gains 0.0915 life-years (9,150 life years per 100,000 people).

Exhibit 3. Life-years gained per 100,000 eligible adults screened by low-dose computed tomography (LDCT) instead of chest x-ray, by aggressiveness of risk targeting in incentive programs

Source/Notes: SOURCE Authors’ analysis. NOTES In 2015, 6.82 million US adults were eligible for annual LDCT screening, as explained in the text. The current baseline estimate is that 3,900 out of every 100,000 eligible adults receive LDCT screening. Conservative, moderate, and aggressive risk targeting are explained in the text.