publication date: May. 9, 2014


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Steven Woolf: Why CMS Should Not Cover LDCT


National coverage for low-dose computed tomography may result in more harm than benefit to the Medicare population at this time, said Steven Woolf, a member of the Medicare Evidence Development & Coverage Advisory Committee.

Speaking at the April 30 MEDCAC hearing, Woolf said coverage would run into many implementation challenges and adherence problems—it would be unlikely that all practices would observe the strict criteria set by the U.S. Preventive Services Task Force and the National Lung Screening Trial, he said.

Woolf is director of the Center on Society and Health, and professor in the Department of Family Medicine and Population Health at the Virginia Commonwealth University.

Following is Woolf’s response to the panel’s first voting question: “How confident are you that there is adequate evidence to determine if the benefits outweigh the harms of lung cancer screening with LDCT in the Medicare population?”

I voted ‘one’ [on a five-point scale]. My reasons are similar to my colleagues in comments I made earlier about questions about whether the magnitude of benefit observed in the NLST is generalizable to the other populations, and concerns about whether the harms could potentially offset some of those benefits, especially if screening extends beyond the narrow risk group that the recommendation applies to.

The point I want to reinforce that my colleagues made is that it’s not realistic to expect lots of NLSTs to get conducted. We’re probably not going to get a better randomized trial than the one we have, but the solution to that is modeling. But those of you who have studied modeling understand that, when you see one … Continue reading 40-19 Steven Woolf on Why CMS Should Not Cover LDCT

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