1. [Insert Organization Name] Making the Case for Lung Cancer Screening

2. © 2014 The Advisory Board Company advisory.com 2 Second Most Prevalent Cancer Type Among Men and Women Source: American Cancer Society, Fancer Facts and Figures 2014, accessed: http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index Leading Cause of Cancer Deaths Top Three Tumor Types 2014 Estimated New Cancer Cases 27% lung cancer deaths as a percentage of total cancer- related deaths 3rd lung cancer third most prevalent tumor type 1st lung cancer is the leading cause of cancer-related deaths 232,670233,000 224,210

3. © 2014 The Advisory Board Company advisory.com 3 Source: J Natl Cancer Inst, 100, no.9 (2008): 630-641; Oncology Roundtable interviews and analysis. Lung Cancer Typically Diagnosed At a Late Stage Non-Small Cell Lung Cancer Five-Year Survival Rates, by Stage at Diagnosis Lung Cancer Stage at Diagnosis

4. © 2014 The Advisory Board Company advisory.com 4 NLST Finds Lung CT Screening Leads to Reductions in Mortality Source: The National Lung Screening Trial Research Team, “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, 365, 2011, accessed: http://www.nejm.org/doi/full/10.1056/NEJMoa1102873http://www.nejm.org/doi/full/10.1056/NEJMoa1102873 A Key Turning Point Study in Brief: National Lung Cancer Screening Trial 2011 study to assess effectiveness of low-dose lung CT screening 53,454 current and former smokers were randomly assigned to be screened once a year for three years with low-dose CT or chest X-ray Participants who received low-dose CT scans had a 20% lower risk of dying from lung cancer than participants who received standard chest X-rays NLST Results, LDCT Total Cases 26,000 Negative72.7% Positive27.3% Incidental Findings 7.5% percentage reduction in lung cancer mortality in participants that received low-dose CT scans as compared to participants who received standard chest X-rays 20%

5. © 2014 The Advisory Board Company advisory.com 5 Commercial Reimbursement for Screening Expected 2015 Source: "Screening for Lung Cancer, U.S. Preventative Services Task Force Recommendation Statement,” USPSTF Final Recommendation Statement, Dec. 2013; Oncology Roundtable interviews and analysisFinal Recommendation Statement NLST Study Prompts USPSTF Approval June, 2013 USPSTF² releases draft recommendation December, 2013 USPSTF gives low-dose CT lung cancer screening “B” recommendation June, 2011 NLST¹ releases initial findings for CT lung cancer screening for high-risk individuals January, 2015 lung cancer screening commercial reimbursement expected to begin 20112013 Timeline for CT Lung Cancer Screening Approval 2015 What USPSTF “B” Recommendation Means for Lung Screening Programs A grade “B” by the USPSTF means that the USPSTF recommends the service and that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial The Affordable Care Act requires that all new private health insurance plans cover all preventative services that are rated at a grade “B” or higher by the USPSTF April, 2014 MEDCAC³ recommends against Medicare coverage for lung screening 2014

6. © 2014 The Advisory Board Company advisory.com 6 Source: Mckee, A et a;., “Rescue Lung, Rescue Life: Translating the NLST results into clinical practice, Oncology Issues, accessed: http://www.nxtbook.com/nxtbooks/accc/oncologyissues_20140304/#/22. http://www.nxtbook.com/nxtbooks/accc/oncologyissues_20140304/#/22 Several Organizations In Support National Comprehensive Cancer Network American Lung Association American Thoracic Society American Society of Clinical Oncology American Association for Thoracic Surgery American Cancer Society American Association of Bronchology and Interventional Pulmonology Society of Thoracic Radiology Society of Thoracic Surgeons International Association for the Study of Lung Cancer Oncology Nursing Society European Society of Thoracic Surgeons American College of Radiology Cancer Care Ontario Societies Recommending CT Lung Cancer Screening

7. © 2014 The Advisory Board Company advisory.com 7 Source: National Lung Screening Trial Research Team “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening” N Engl J Med. 2011 Aug 4;365(5):395-409. Epub 2011 Jun 29. “Screening for Lung Cancer”, USPSTF, http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm ; Shaffer A, “CT Screening Evolves Amid Questions and Controversy”, OncLLive, http://www.onclive.com/publications/obtn/2012/september-2012/ct-screening-evolves-amid-questions-and-controversy/2; http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htmhttp://www.onclive.com/publications/obtn/2012/september-2012/ct-screening-evolves-amid-questions-and-controversy/2 Comparing Screening Criteria Organization Criteria National Lung Screening Trial (NLST) 55-74 years old, 30 + pack years, stopped smoking less than 15 years ago United States Preventive Services Task Force (USPSTF) 55-80 years old, 30+ pack years, stopped smoking less than 15 years ago Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative surgery National Comprehensive Cancer Network (NCCN) Category 1a: 55-74 years old, 30 + pack years, stopped smoking less than 15 years ago Category 2b: 50-74, 20+ pack years, have one additional risk factor excluding second hand smoke Risk factors include: tobacco smoking, contact with radon, contact with asbestos or other cancer-causing agents (chromium, arsenic, beryllium, cadmium, nickel, coal smoke, soot, silica and diesel fumes, having had certain other cancers, family who’ve had lung cancer, having had other lung diseases (COPD, pulmonary fibrosis)

8. © 2014 The Advisory Board Company advisory.com 8 [ Insert Program Screening Criteria Here]

9. © 2014 The Advisory Board Company advisory.com 9 Comparing Mammography and Low-Dose Lung CT Screening Source: National Lung Screening Trial Research Team “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening” N Engl J Med. 2011 Aug 4;365(5):395- 409. Epub 2011 Jun 29. “Screening for Lung Cancer”, USPSTF, http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm Putting It Into Context MammographyLow-dose CT Lung Cancer Screening False positive rate 10-12%20-25% False discovery rate 96% False positive biopsy rate 7-15%0.4-2.4% Number of individuals need to be screened in order to save one life ~800-900320

10. © 2014 The Advisory Board Company advisory.com 10 Compares Favorably Compared to Other Screening Types Source: Pyenson B et al., “An Actuarial Analysis Shows That Offering Lung Cancer Screening as An Insurnace Benefit Would Save Lives at Relatively Low Cost,” Health Affairs 31(4); Oncology Roundtable interviews and analysis. 1)Analysis of lung cancer patient volumes at an academic medical center that sees 5,508 new patients per year; calculations based on 463 new diagnoses of lung cancer. Early Detection Boosts Cost-Effectiveness Shift in Stage of Diagnosis Due To CT Screening Change in Number of Lung Cancer Patients Diagnosed by Stage 1 Screening Cost Effectiveness Cost Per Life-Year Saved 434% (25%) (93%) Stage AStage BStage C Lung CT Screening Cervical Screening Breast Screening Colorectal Screening $11- 26 K $50- 75 K $18- 28 K $31- 51 K

11. © 2014 The Advisory Board Company advisory.com 11 Source: Pyenson B et al., “An Actuarial Analysis Shows That Offering Lung Cancer Screening as An Insurnace Benefit Would Save Lives at Relatively Low Cost,” Health Affairs 31(4); Oncology Roundtable interviews and analysis. Early Detection Boosts Cost Effectiveness (cont.) Study in Brief: Milliman Actuarial Analysis 2012 actuarial analysis of the effects of LDCT lung cancer screening on outcomes and cost Lung CT screening would shift detection from late stages to early stages, resulting in 130,000 more lung cancer survivors in 2012 Authors concluded that offering LDCT screening as an insurance benefit would save lives at low cost compared to routine screenings for other cancers

12. © 2014 The Advisory Board Company advisory.com 12 Source: The National Lung Screening Trial Research Team, “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, 365, 2011, accessed: http://www.nejm.org/doi/full/10.1056/NEJMoa1102873http://www.nejm.org/doi/full/10.1056/NEJMoa1102873 Not A Significant Volume Burden Apply 3-5% volume estimate to market, or physician panel size individuals at “high-risk” for developing lung cancer, according to NLST estimates 10M Primary physician patient panel of 1,000 patients can potentially have about 50 patients that would be eligible for lung CT screening 1,000 x 5% = 50 patients

13. © 2014 The Advisory Board Company advisory.com 13 Screening Follow-Up Managed by Program Add Text Here Lung Cancer Screening Program Flow Map

14. © 2014 The Advisory Board Company advisory.com 14 [Insert Sample Screening Results Report Here]

15. © 2014 The Advisory Board Company advisory.com 15 Insert Program Contact Information 202.XXX.XXXX [Email address] [Website URL] For more information, contact us at: John Smith XXXXXXXX