Costs of Biopsy and Complications in Patients with Lung Cancer

Abstract

Purpose

To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer.

Patients and Methods

Observational study using data from IBM Marketscan^® Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies.

Results

The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40–80%. Complications account for 13% of total costs.

Conclusion

Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs.

Keywords:

• cancer
• diagnosis
• economics
• frequency

Ethics Approval and Informed Consent

As the database is fully de-identified and compliant with HIPAA regulations this study was deemed exempt by the Louisiana State University Health Sciences Center – New Orleans Institutional Review Board.

Acknowledgments

Intuitive Surgical, Sunnyvale, CA, USA sponsored the study. The sponsor was involved in the study design, collection, analysis, and interpretation of data, as well as data checking of information provided in the manuscript. The abstract of this paper was presented at ISPOR May 2020 (a virtual conference) as a poster presentation with interim findings. The poster’s abstract was published in Value in Health, 23 (Supplement 1, May 2020) Abstract PN137, S47. Available at: https://www.sciencedirect.com/journal/value-in-health/vol/23/suppl/S1?page=3

Author Contributions

The authors had unrestricted access to study data and were responsible for all content and editorial decisions. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

OW and JL are employees of Intuitive Surgical. YWC, YHK, MJS, DEO, RAC, and DGS received grants for the development of this publication from Intuitive Surgical. MJS is the principal investigator and FDA Medical Expert for the new national multicenter trial of injectable chemotherapeutic and was a consultant for product development for Auris Health. The authors received no honoraria related to the development of this publication. The authors report no other conflicts of interest in this work.