Biopsies overused in diagnosing lung cancer, according to Medicare cost analysis

Biopsies were found to be the most costly tool prescribed in lung cancer diagnosis, according to research presented today at the 2014 Multidisciplinary Symposium in Thoracic Oncology in Chicago, Illinois.

The study examined the utilization rates and estimated the Medicare costs of the lung cancer diagnostic workup in patients who had an abnormal chest computed tomography (CT) scan. The results of this study show that the total diagnostic workup cost for the study sample of patients was $38.3 million.

Of the total diagnostic workup cost, 43% ($16.5 million) is attributed to the biopsy costs for the 761 patients in the study sample who had negative biopsies and who did not have a lung cancer diagnosis during the following year.

The retrospective study used a random 5% sample of Medicare beneficiaries from January 1, 2009 through December 31, 2011. From that sample, 8,979 eligible patients were identified who were 65 to 74 years old with an abnormal chest CT scan between July 1, 2009 and December 31, 2010.

Of the patients included in the analysis, the mean age was 69.3 years, and 56% of patients were female. During a 12-month period, 13.9% of patients were found to have lung cancer, and the median time from abnormal chest CT scan to lung cancer diagnosis was 11 days.

Diagnostic tests used until a patient was diagnosed with lung cancer included chest CT scans, chest radiographs, lung biopsies, and positron emission tomography (PET) scans. Chest radiographs were used for 54% of patients, chest CT scans were ordered for 33% of patients, and lung biopsies were utilized for 19% of patients. PET scans were used for 0.4% of patients. Of the patients who had lung biopsies, 44% had negative findings, and lung cancer was not diagnosed during follow-up.

The study calculated the associated Medicare procedure costs for each of the diagnostic tests used in this cohort of patients. For lung biopsies, the cost analysis combined the procedure costs and all incidental costs including physician costs, anesthesia services and adverse event costs. For patients with a lung cancer diagnosis, the average total cost of the diagnostic workup was $7,567 (standard deviation (SD) = $11,062). In patients with no lung cancer diagnosis, the average total cost of the diagnostic workup was $3,558 (SD = $23,089).

The median cost of each biopsy procedure was $3,784, with a mean cost of $14,634 (SD = $32,271). The average cost of a lung biopsy with complications (adverse events) was approximately four times higher than a complication-free biopsy ($37,745 vs. $8,869). Adverse events were reported in 19% of patients who underwent a lung biopsy.

From this analysis, it was found that the National Comprehensive Cancer Network (NCCN) lung cancer screening guidelines were not followed, which resulted in many patients who ultimately had a negative lung cancer diagnosis undergoing unnecessary biopsies. The NCCN guidelines call for low-dose computed tomography of the chest followed by a PET scan to identify patients for biopsy.

“These results suggest that since NCCN guidelines are not being followed, there is a need to develop more precise risk stratification tools to better identify patients who require lung biopsies,” said lead author Tasneem Lokhandwala, MS, PhD, a data analyst at Xcenda, an AmerisourceBergen company, in Palm Harbor, Florida.
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