Chicago, IL—A large study based on Medicare claims data reveals an opportunity to substantially cut costs of lung cancer screening, while improving quality of care. Based on this study, lung biopsies are the most expensive modality used in the diagnostic workup of patients with an abnormal chest computed tomography (CT) scan, and as many as 43.7% of the biopsies according to this study are unnecessary and are in contrast to the National Comprehensive Cancer Network (NCCN) lung cancer screening guidelines recommendations.
The current NCCN guidelines recommend the use of a positron emission tomography (PET) scan after an abnormal CT scan to identify patients who would benefit from a lung biopsy. The study, which was presented at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology, showed that the diagnostic workup costs after an abnormal CT scan totaled $38.3 million. Of this, 43.1% ($16.5 million) was attributed to the biopsy costs of 761 patients included in the sample who had negative biopsies and were not diagnosed with lung cancer in the following year.
“This study provides a baseline of current costs for the lung cancer diagnostic workup prior to the introduction of major lung cancer screening programs. Biopsy costs comprise a significant proportion of the overall cost of diagnosing lung cancer, and biopsies significantly increase the costs in patients who are diagnosed with lung cancer, and those who aren’t,” said Tasneem Lokhandwala, MS, PhD, a data analyst at Xcenda in Palm Harbor, FL.
The study population was culled from a random sample of Medicare beneficiaries. A total of 8979 eligible patients were identified (aged 65-74 years; mean age, 69.3 years) who had an abnormal chest CT scan between July 1, 2009, and December 31, 2010.
During a 12-month study period, 13.9% (1249) of the patients were diagnosed with lung cancer; the median time from abnormal CT scan to lung cancer diagnosis was 11 days.
As part of the diagnostic workup, chest x-rays were ordered for 54.4% (N = 4885) of patients, chest CT scans were ordered for 32.9% (N = 2954), and lung biopsies were done in 19.4% (N = 1742). PET scans were ordered for a mere 0.4% (N = 36) of the patients.
Lung biopsies were negative in 43.7% (N = 761) of the patients who had a biopsy; none of these patients was diagnosed with lung cancer during follow-up.
Cost Impact and Biopsy Complications
The average associated Medicare cost of the diagnostic workup totaled $7567 for patients diagnosed with lung cancer and $3559 for those not diagnosed with lung cancer.
Looking at the cost analysis of lung biopsies (procedure costs, and all incidental costs including physician cost, anesthesia services, and adverse events), for each biopsy, the median cost was $3874, and the mean cost was $14,364.
The average cost of a lung biopsy with complications (ie, adverse events) was approximately 4 times higher than a biopsy without complications—$37,745 versus $8869, respectively. Complications were reported in 19.3% (N = 336) of patients who underwent a lung biopsy.
“We need better identification of patients who need lung biopsy in order to reduce costs and improve patient outcomes. These could include better imaging, follow-up PET, and liquid biopsies,” Dr Lokhandwala stated.
Commenting on the study results, Laurie E. Gaspar, MD, MBA, Chair, Department of Radiation Oncology, University of Colorado, Denver, said, “It is important to bear in mind the associated costs and potential harms of diagnostic tests. The cost of unnecessary biopsies in patients who did not have lung cancer include adverse events and emotional stress.”