Reducing Lung Biopsies May Cut Costs, Improve Patient Outcomes

Biopsies were found to be the most costly tool used in lung cancer diagnosis, and may be performed too frequently based on negative test results and adverse events, according to a Medicare claims analysis presented at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology.

The analysis looked at utilization rates and estimated the Medicare costs of the lung cancer diagnostic workups of patients with an abnormal chest CT scan. The retrospective study used a random sample from the 5% of the Medicare Claims Database (2009-2011).

“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,” lead author Tasneem Lokhandwala, PhD, MS, a data analyst at Xcenda in Palm Harbor, Florida, said at the symposium. “Reducing the number of patients who are referred for lung biopsies has the potential to decrease Medicare costs and ultimately improve patient outcomes.”

The study population consisted of patients aged 65-74 years who had an abnormal CT scan between July 1, 2009 and December 31, 2010 (n = 8,979). Patients were excluded if they had been diagnosed with cancer, pneumonia, atelectasis or tuberculosis in the 6 months preceding the abnormal CT scan or if they were not continuously Medicare-eligible during the entire study period, which included a 12-month follow-up. The mean patient age was 69.3 years, 86.5% of patients were Caucasian, and 43.6% were male.

Of the study population, 13.9% (n = 1,249) of patients were diagnosed with lung cancer during a 12-month period. The median time to diagnosis was 11 days. Diagnostic tests included chest x-rays (54.4% of patients; n = 4,886), CT scans (32.9% of patients; n = 2,958), PET scans (0.5% of patients; n = 47), and lung biopsy (19.4% of patients; n = 1,744).

The analysis included estimated Medicare costs for each type of diagnostic test. The average cost of a chest x-ray was $19, a CT scan was $184, and a PET scan was $624. Costs were calculated by analyzing claims with a CPT code for each specific service.

Biopsy claims were notably more complex: the average cost was $14,634, including all costs associated with that procedure. “This approach enabled the capture of other services and adverse events associated with a biopsy,” said Lokhandwala.

Of the 1,744 patients who received a lung biopsy, 19.3% (n = 336) experienced a biopsy-related adverse event (those included were hemorrhage, pneumothorax and respiratory failure requiring mechanical ventilation). The average cost of a biopsy with adverse events was approximately four times higher than a complication-free biopsy ($37,745 compared to $8,869).

Overall, the total diagnostic costs for the study population were $38.3 million. Of the total workup costs, $16.5 million (43.1%) was accounted for by negative biopsies.

“These results show that we need to develop more precise risk stratification tools to better identify patients who require referrals for lung biopsy. Doing so has the potential to reduce costs and improve patient outcomes,” Lokhandwala said. “Additionally, clinicians should consider noninvasive testing methods first and we should also increase our focus on developing less invasive tests.”

According to the National Comprehensive Cancer Network lung cancer screening guidelines, clinicians should use low-dose CT of the chest followed by a PET scan to identify patients for lung biopsy. This analysis indicated that many patients who ultimately had a negative lung cancer diagnosis underwent unnecessary biopsies, including biopsy-related adverse events.

Lokhandwala T, Dann R, Johnson M, et al. Costs of the Diagnostic Workup for Lung Cancer - A Medicare Claims Analysis. Presented at: 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology; October 30-November 1, 2014; Chicago, Illinois. Presentation Number: 103.

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