Comparing the downstream costs and healthcare utilization associated with the use of low-dose computed tomography (LDCT) in lung cancer screening in patients with and without alzheimer’s disease and related dementias (ADRD)

Abstract

Objective

This study aims to compare the downstream costs and healthcare utilization associated with using low-dose computed tomography (LDCT) for lung cancer screening in patients with and without Alzheimer’s disease and related dementias (ADRD).

Methods

Based on data from IBM MarketScan Commercial Claims Databases (2014–2018), we have identified four study cohorts: ADRD and non-ADRD patients who went through LDCT screening; ADRD and non-ADRD patients without LDCT screening. Annually healthcare utilization and cost were grouped into outpatient, inpatient, and pharmacy. We used difference-in-differences (DID) models to estimate the downstream healthcare utilization and cost associated with LDCT screening in both ADRD and non-ADRD population. We used a difference-in-difference-in-differences (DDD) model to explore whether LDCT screening was associated with higher downstream cost and healthcare utilization in ADRD population than non-ADRD population.

Result

Compared to individuals without LDCT screening, LDCT screening was associated with increased outpatient visits (2.1, 95% CI 0.7, 3.4) and outpatient cost ($2301.0, 95% CI 296.2, 4305.8) in the ADRD population and increased outpatient visits (0.6, 95% CI 0.1, 1.1) in the non-ADRD population within 1 year after screening. Compared with the non-ADRD population, LDCT screening was found to be associated with an additional 1.5 (95% CI 0.2, 2.8) outpatient visits, 0.7 (95% CI 0.1, 1.3) days of inpatient stays, and $4,960.4 (95% CI 532.7, 9388.0) in overall healthcare costs within 1-year after LDCT in the ADRD population (all p < .5).

Conclusion

The downstream cost and healthcare utilization associated with LDCT screening were found to be higher in the ADRD population compared to the average population.

Keywords:

• Lung cancer screening
• low-dose computed tomography
• Alzheimer’s disease and related dementias
• healthcare utilization
• expenditures

Transparency

Declaration of funding

This work was funded by the National Institutes of Health (NIH) National Cancer Institute (NCI) grants 5R01CA246418-02 and 3R01CA246418-02S1. YG and JB were also funded in part by the NIH NCI grants 1R21CA245858-01A1, 3R21CA245858-01A1S1, and 1R21CA253394-01A1, and NIH National Institute on Aging (NIA) grant 5R21AG068717-02.HS, YG and JB were partially funded by the Centers for Disease Control and Prevention (CDC) grant U18DP006512.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Khalid A. Alkhuzam (Department of Pharmaceutical Outcomes and Policy at University of Florida College of Pharmacy) for assistance in reviewing/editing the manuscript.

Author contributions

Study concept and design: HS and YG; Acquisition, analysis, or interpretation of data: All authors; Drafting of the manuscript: YZ, HS, YG; Critical revision of the manuscript for important intellectual content: JH, SY, and JB; Statistical analysis: YZ; Administrative, technical, or material support: HS; Study supervision: HS and YG; YZ had access to the data and take responsibility for the accuracy of the analysis.