FROM A SYMPOSIUM IN THORACIC ONCOLOGY
CHICAGO (FRONTLINE MEDICAL NEWS) – Biopsies performed in patients ultimately not diagnosed with lung cancer accounted for 43% of the $38.3 million spent in lung cancer diagnostic costs in a Medicare analysis.
“We need to develop more precise risk stratification tools to better identify patients who require referrals for lung biopsy. This has the potential to reduce costs and improve patient outcomes,” study author Tasneem Lokhandwala, Ph.D., said during a press briefing at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology . To estimate the use of diagnostic tests in lung cancer diagnosis and detection as well as the costs incurred by Medicare patients, Dr. Lokhandwala and her associates used a random 5% sample of Medicare patients from Jan. 1, 2009 through Dec. 31, 2011.
In all, 8,979 patients, aged 65-74 years, were identified with an abnormal computed tomography scan from July 1, 2009 through Dec. 31, 2010. Their mean age was 69.3 years, 43.6% were male, and 86.5% white.
The date of the patient’s abnormal CT scan was defined as the index date. Patients diagnosed with any cancer, pneumonia, atelectasis, or tuberculosis in the 6-month preindex period were excluded.
During the 12-month follow-up period, 14% of patients were diagnosed with lung cancer, with a median time to diagnosis from the abnormal chest CT of 11 days.
Diagnostic tests used were chest x-rays for 54.4%, chest CT scans for 33%, chest positron emission tomography scans for 0.5%, and lung biopsy for 19.4%, Dr. Lokhandwala, a data analyst at Xcenda, Palm Harbor, Fla., reported.
Importantly, the National Comprehensive Cancer Network guidelines call for low-dose chest CT followed by a PET scan to identify patients for biopsy.
In terms of financial costs, the average total cost of the diagnostic work-up was $7,567 for patients diagnosed with lung cancer and $3,558 for those without a lung cancer diagnosis.
For both groups, these costs rose dramatically with the use of biopsy to $8,341 and $22,127, respectively, Dr. Lokhandwala said.
Of the 1,744 patients who underwent a biopsy, 19.3% experienced a biopsy-related adverse event. An adverse event increased the average cost of a biopsy fourfold from $8,869 to $37,745, she said.
“Apart from the financial costs and the adverse events associated with tests and biopsies, there was also likely tremendous stress for those patients who ultimately were not found to have lung cancer,” press briefing moderator Dr. Laurie E. Gaspar, professor and chair of radiation oncology at the University of Colorado at Denver, Aurora, said.
Dr. Gaspar agreed that the data highlight the need to better identify patients with lung cancer through the use of better imaging tests, follow-up CT or PET scans, or liquid biopsies.
