Health for life

Testing for hidden early lung cancer

Remember this article on screening for lung cancer? 

More than 54,000 former and current tobacco users who looked like they were free of cancer were randomly assigned to a yearly cheapo chest x-ray vs. a yearly pricey low-radiation-dose CAT scan. Over 5 to 7 years of follow-up, the CAT scan was better at picking up early lung cancer (119 cases) which translated into a small but statistically significant survival advantage of 62 lives saved per 100,000 patient years.

Does this mean that Medicare, Medicaid and all commercial insurers should "cover" a baseline and yearly follow-up screening CAT scan for tobacco smokers at risk for lung cancer?  According to actuary Bruce Pyenson and colleagues writing in the latest issue of Health Affairs, the answer may be yes.

The Disease Management Care Blog thinks the answer may still be no. 

Is it being a heartless curmudgeon?  Read on and decide for yourself.......

In the Health Affairs article, the authors assumed current and former tobacco smokers comprise about 30% of persons aged 50-64 years.  They further assumed that about 50% of persons at risk would agree to the CAT screening exam.  Based on prior studies, they estimated that 21% of the baseline scans and 7% of the follow-up yearly scans would require additional testing and figured lung cancers would be present in 0.6% and 0.2% of the baseline and follow-up scans. They used a fee rate of $247 per screening for both the scan and included the cost of a counseling session on smoking cessation.  

Spread over a population, the cost of the screening would amount to 76 cents per member per month (PMPM). On a nationwide basis, there would be 130,000 additional lung cancer survivors.  The cost per life-year saved in 2012 dollars would range between $11,708 and $26,016.  To put things in perspective, it costs more per life-year saved to use current screening approaches to cervical cancer with pap smears (more than $50,000), colon cancer with colonoscopies ($18,000 to $29,000) and mammography ($31,000 to $51,000).

Much of the high costs of these other cancer screening procedures are the result of more persons being eligible for the testing.  In the Health Affairs study, the only persons getting the scan are smokers who are at high risk.

What did the DMCB learn?

One important lesson in this study is that cancer screening is not free.  Its too easy to assume that the early detection provided by mammography, colonoscopies and pap smears pays for itself.  Thats simply not true.  What is true is that cancer screening is good value, but itll still cost you for each life saved.

The second lesson is that good value still represents incremental cost.  As a result, the 76 cents PMPM is in addition to the money already being spent by health insurers.  While the extra pennies doesnt seem like a lot of money, the health insurance dollar is comprised of coverage of similarly priced goods and services, and all those pennies are continuing to add up.  The DMCB thinks were getting to the point where the U.S. would need to ask what coverage of which service should be cut to pay for lung cancer screening.

Both of these issues make it unlikely that insurers will willingly include coverage of screening CAT scans in their health insurer benefit.  They can also argue that it would be highly unusual to decide to cover a new screening procedure based on a single study that hasnt even been reviewed yet by the U.S. Preventive Health Services Task Force.

Last but not least, the DMCB is willing to bet that there wont be much consumer demand for coverage by insurers because of bias against the victims of tobacco-associated illnesses as well as the argument that smokers should self-pay based on the comparative cost of a years worth of cigarettes.

It remains to be seen if, under their ability to define a minimum insurance benefit as part of the Affordable Care Act, the Feds will require lung cancer screening.

Stay tuned!

Image from Wikipedia

Perhaps you bent the wrong way while lifting something heavy. Or youre dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say theyve had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.

Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PT, DPT, PhD, associate professor of Physical Therapy at the University of Maryland School of Medicine. "Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes," she says. After 48 hours, you can switch to heat if you per. Whether you use heat or ice -- take it off after about 20 minutes to give your skin a rest.
Keep moving. "Our spines are like the rest of our body -- theyre meant to move," says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once youre feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you -- and your back -- more mobile. Just dont overdo it. Theres no need to run a marathon when your back is sore.
Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. "They help you maintain the proper posture and alignment of your spine," Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.
Stretch. Dont sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. "Because most of us spend a lot of time bending forward in our jobs, its important to stand up and stretch backward throughout the day," Reicherter says. Dont forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.
Think ergonomically. Design your workspace so you dont have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.
Watch your posture. Slumping makes it harder for your back to support your weight. Be especially caul of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.
Kick the habit. Smoking can increase your risk for osteoporosis of the spine and other bone problems. Osteoporosis can lead to compression fractures of the spine. One study found that smokers are about a third more likely to have low back pain compared with nonsmokers.
Watch your weight. Use diet and exercise to keep your weight within a healthy range for your height. Being overweight puts excess stress on your spine.
Try an over-the-counter pain reliever. Anti-inflammatory drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naproxyn), and aspirin can help reduce back pain and swelling. Acetaminophen (Tylenol) is another over-the-counter option for pain management. Be sure to check with your doctor or pharmacist about any interactions over-the-counter pain relievers may have with other medications you are taking. People with a history of certain medical conditions (such as ulcers, kidney disease, and liver disease) should avoid some medicines

Older men who have low levels of vitamin B12 have a higher risk of having fractures. These are the findings of researchers at the Sahlgrenska Academy as a part of an international study of a total of 1000 older men.

Osteoporosis is one of the worlds most widespread diseases, and intensive research is under way worldwide to identify its causes and to be able to prevent fractures.

In an extensive study, researchers at the Sahlgrenska Academy at the University of Gothenburg can now show that low levels of vitamin B12 in the blood increases the risk of fractures in older men.

International research project
This study is a part of an international research project initiated by the National Institutes of Health (NIH) in the US and comprises 11,000 men in total. In their part of the study, the Gothenburg researchers studied 1,000 Swedish men, MrOS Sweden, with an average age of 75, and used various methods to analyze the blood concentrations of the B vitamins B12 and folate, which are found in our food naturally.

Higher fracture risk
The results show that the risk of suffering a fracture six years later was higher among men who had low B12 levels at the beginning of the study than men with normal B12 levels. In the quartile with the lowest B12 content, the risk was elevated by approximately 70 percent compared with the others. The risk increase pertained primarily to fractures in the lumbar region, where the risk increase was up to 120 percent.

"The higher risk also remains when we take other risk factors for fractures into consideration, such as age, smoking, BMI, BMD (bone mineral density), previous fractures, physical activity, the D-vitamin content in the blood and calcium intake," says Catharina Lewerin, researcher at the Sahlgrenska Academy.

Does this mean that older men can prevent fractures by eating more vitamin B12?

"It has not been scientifically established, but such studies are under way, including one large Dutch study where older individuals over the age of 65 are treated with both vitamin B12, folic acid and vitamin D to investigate the occurrence of fractures.

"Right now, there is no reason to eat more vitamin B12, but rather treatment shall only be applied in confirmed cases of deficiencies and in some cases to prevent deficiencies. For anyone who wants to strengthen their bones and prevent fractures, physical activity 30 minutes a day and quitting smoking is good self care," says Catharina Lewerin.

New method

In this study, the researchers used a relatively new method called holotranscobalamin, which measures the amount of vitamin that is taken up in the cells, which is considered to be a more sensitive test for B12 deficiency.

The article was published online in Osteoporosis International.