A retrospective analysis of delays in the diagnosis of lung cancer and associated costs

Figures & data

Figure 1 Patient selection and inclusion.

Figure 2 Kaplan–Meier survival curves of mortality by stage of disease.

Table 1 Characteristics of all NSCLC patients at baseline and by cancer stage

Characteristics	All NSCLC (n=1,210), mean (SD)	Stage I (n=179), mean (SD)	Stage II (n=130), mean (SD)	Stage IIIa (n=65), mean (SD)	Stage IIIb (n=279), mean (SD)	Stage IV (n=557), mean (SD)	P-value
Age (years)	59 (8)	60 (7)	59 (8)	58 (11)	59 (8)	59 (9)	0.803
Follow-up (years)	1.1 (0.9)	1.5 (1.0)	1.4 (1.0)	1.8 (1.2)	1.1 (0.9)	0.9 (0.8)	<0.001
Baseline Charlson comorbidity index	3.6 (2.8)	2.9 (1.9)	3.2 (2.2)	3.3 (2.6)	3.4 (2.7)	4.0 (3.1)	<0.001
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Age categories (years)
18–34	5 (<1)	0 (0)	0 (0)	2 (3)	0 (0)	3 (<1)	0.008
35–44	35 (3)	3 (2)	4 (3)	3 (5)	10 (4)	15 (3)	0.699
45–54	293 (24)	38 (21)	31 (24)	19 (29)	68 (24)	137 (25)	0.769
55–64	626 (52)	106 (59)	67 (52)	22 (34)	142 (51)	289 (52)	0.014
65–74	200 (17)	29 (16)	23 (18)	16 (25)	46 (16)	86 (15)	0.448
≥75	51 (4)	3 (2)	5 (4)	3 (5)	13 (5)	27 (5)	0.460
Gender
Male	682 (56)	79 (44)	79 (61)	37 (57)	157 (56)	330 (59)	0.008
Female	528 (44)	100 (56)	51 (39)	28 (43)	122 (44)	227 (41)	0.008
Geographic region
Northeast	127 (11)	20 (11)	14 (11)	5 (8)	31 (11)	57 (10)	0.939
Midwest	336 (28)	51 (28)	27 (21)	12 (18)	81 (29)	165 (30)	0.125
South	628 (52)	86 (48)	80 (62)	41 (63)	147 (53)	274 (49)	0.028
West	119 (10)	22 (12)	9 (7)	7 (11)	20 (7)	61 (11)	0.236
Death during study period	467 (39)	20 (11)	22 (17)	18 (28)	107 (38)	300 (54)	<0.001

Abbreviations: NSCLC, non-small-cell lung cancer; SD, standard deviation.

Table 2 Summary of diagnostic testing in 12 months prior to the date of diagnosis

Diagnostic testing	All NSCLC (n=1,210)	Stage I (n=179)	Stage II (n=130)	Stage IIIa (n=65)	Stage IIIb (n=279)	Stage IV (n=557)
Use of diagnostic tests, n (%)
Imaging	1,127 (93)	166 (93)	124 (95)	65 (100)	258 (92)	514 (92)
CT*	911 (75)	143 (80)	102 (78)	58 (89)	212 (76)	396 (71)
PET*	487 (40)	109 (61)	76 (58)	32 (49)	109 (39)	161 (29)
MRI	11 (1)	2 (1)	1 (1)	1 (2)	3 (1)	4 (1)
X-ray*	1,084 (90)	165 (92)	124 (95)	64 (98)	251 (90)	480 (86)
Other (chest/lung)	38 (3)	3 (2)	3 (2)	4 (6)	10 (4)	18 (3)
Other	788 (65)	118 (66)	79 (61)	43 (66)	177 (63)	371 (67)
Total imaging tests received	3,319	540	385	202	762	1,430
Laboratory/pathology*,a	770 (64)	120 (67)	91 (70)	49 (75)	175 (63)	335 (60)
Biopsy	572 (47)	81 (45)	77 (59)	37 (57)	149 (53)	228 (41)
Bronchoscopic	404 (33)	45 (25)	58 (45)	30 (46)	105 (38)	166 (30)
With navigational bronchoscopy*,b	6 (1)	0 (0)	1 (2)	0 (0)	3 (3)	2 (1)
With ultrasound*,b	28 (7)	1 (2)	5 (9)	2 (7)	10 (10)	10 (6)
Percutaneous*	245 (20)	50 (28)	33 (25)	15 (23)	58 (21)	89 (16)
Open surgery	19 (2)	3 (2)	2 (2)	3 (5)	7 (3)	4 (1)
Total biopsies received	668	98	93	48	170	259
Time from initial prediagnostic test to diagnosis (months), mean (SD)	5.4 (4.2)	6.2 (4.1)	5.7 (4.2)	6.2 (4.1)	5.2 (4.2)	5.0 (4.2)

Notes:

* P<0.05 across stage cohorts.

a Including cytopathology, molecular cytogenetics, surgical pathology, gross, and microscopic examination.

b Subset of bronchoscopic biopsy, includes linear or radial endobronchial ultrasound.

Abbreviations: NSCLC, non-small-cell lung cancer; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography; SD, standard deviation.

Table 3 Health care utilization rates and per-member per-month costs in the NSCLC cohort pre- and postdiagnosis

Health care utilization	All NSCLC (n=1,210)	Stage I (n=179)	Stage II (n=130)	Stage IIIa (n=65)	Stage IIIb (n=279)	Stage IV (n=557)
Prior to diagnosis
Office visits	14.5	16.7	15.9	16.9	13.9	13.6
Outpatient visits	9.3	11.4	9.4	10.5	9.3	8.6
Emergency room visits	1.0	0.9	0.8	0.8	0.8	1.1
Hospitalizations	0.5	0.6	0.6	0.6	0.4	0.5
Total health care costs (USD)	$2,407 (3,364)	$2,667 (3,421)	$2,456 (2,790)	$2,121 (2,359)	$2,503 (4,016)	$2,298 (3,209)
Medical costs	$2,202 (3,252)	$2,429 (3,370)	$2,209 (2,629)	$1,939 (2,207)	$2,299 (3,924)	$2,109 (3,074)
Physician office/clinic	$343 (1,014)	$342 (550)	$337 (531)	$385 (595)	$372 (1,487)	$325 (962)
Inpatient	$1,110 (2,432)	$1,167 (2,266)	$1,124 (2,165)	$879 (1,713)	$1,207 (3,228)	$1,066 (2,138)
Emergency room	$18 (35)	$17 (31)	$15 (28)	$22 (37)	$16 (31)	$19 (39)
Hospital outpatient	$664 (1,393)	$788 (1,376)	$670 (950)	$602 (802)	$638 (854)	$644 (1,720)
Other	$67 (349)	$114 (717)	$64 (196)	$51 (116)	$65 (206)	$55 (259)
Pharmacy costs	$206 (393)	$238 (333)	$247 (495)	$182 (306)	$204 (420)	$189 (379)
After diagnosis
Office visits	43.4	29.7	39.1	43.7	48.6	48.8
Outpatient visits	28.6	18.2	19.3	24.0	35.4	33.9
Emergency room visits	1.6	1.1	1.2	1.3	1.9	1.9
Hospitalizations	1.6	1.0	1.1	1.3	1.6	2.0
Total health care costs (USD)*	$16,577 (33,550)	$7,239 (7,611)	$9,484 (8,520)	$11,193 (8,826)	$17,415 (53,839)	$21,441 (29,777)
Medical costs*	$15,856 (33,517)	$6,888 (7,499)	$9,100 (8,433)	$10,542 (8,729)	$16,743 (53,840)	$20,490 (29,804)
Physician office/clinic*	$3,566 (4,513)	$1,343 (2,733)	$2,221 (2,146)	$3,345 (3,856)	$3,461 (4,546)	$4,673 (5,053)
Inpatient	$7,102 (31,241)	$3,449 (5,383)	$3,831 (5,292)	$3,455 (4,790)	$7,740 (52,049)	$9,145 (27,139)
Emergency room	$79 (388)	$30 (57)	$37 (83)	$46 (72)	$69 (161)	$113 (555)
Hospital outpatient*	$4,644 (6,842)	$1,877 (3,207)	$2,697 (4,236)	$3,345 (4,171)	$5,106 (5,626)	$5,907 (8,441)
Other	$466 (2,445)	$188 (467)	$315 (1,299)	$351 (1,321)	$367 (983)	$653 (3,432)
Pharmacy costs*	$721 (1,071)	$351 (486)	$384 (558)	$651 (811)	$672 (941)	$951 (1,305)

Notes: Data are expressed as % or USD mean (standard deviation).

* P<0.05 across stage cohorts.

Abbreviations: NSCLC, non-small-cell lung cancer; ER, emergency room.

Figure 3 Comparison of per-patient per-month (PPPM) total health care costs pre- and postdiagnosis for non-small-cell lung carcinoma patients.