OBJECTIVES: Annual screening for lung cancer by low-dose computed tomography (LDCT) reduces mortality. Despite no cost-share for covered individuals, limited availability and frequent ‘false alarm’ findings have impeded widespread adoption, diminishing potential population health gains. We examined a model of the clinical and economic effects of introducing an accessible blood-based genomic test (BGT) used as a pre-screen to support more rapid and refined uptake of LDCT screening within the US Medicare population.

METHODS: A 6-million subject Monte Carlo simulation compared two scenarios in the Medicare screening-eligible population: (A) base-case whereby LDCT screening increases from 6% (year-1) to 9.3% (year-5); (B) base-case plus an additional 10% uptake with the BGT going from 16% (year-1) to 19.3% (year-5). Model inputs were derived from SEER, published LDCT clinical trials, CISNET Smoking History Generator for population smoking patterns, Optum360 database for screening and diagnostic costs, and published lung cancer treatment costs. We assumed the BGT had lower sensitivity, cost more than LDCT, had higher uptake, and that cancer treatment costs rose 6% per year.

RESULTS: Over the 5-year time horizon, the base-case plus BGT scenario led to a 3.8% increase in stage 1 diagnoses, a 3.4% decrease in stage 4 cancers, and an additional 1,024 lung cancer deaths avoided over LDCT alone. The number of screening LDCTs needed to detect a cancer dropped 22.7%. The false-positive to true-positive rate for LDCT improved 23.4%. Reduction in the cost of lung cancer treatment due to earlier stage detection offset 29.3% of spending on the BGT.

CONCLUSIONS: Model results suggest that a hypothetical, more expensive BGT with poorer sensitivity and specificity than LDCT that is used to improve both uptake and efficiency of LDCT screening could yield important population-level health gains while constituting an efficient use of healthcare resources.