Costs of Diagnostic Assessment for Lung Cancer: A Medicare Claims Analysis
Costs of Diagnostic Assessment for Lung Cancer: A Medicare Claims Analysis
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DOI：
10.1016/j.cllc.2016.07.006
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发表时间：
2017-01-01
影响因子：
3.6
通讯作者：
Carbone, David P.
中科院分区：
文献类型：
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作者：
Lokhandwala, Tasneem;Bittoni, Marisa A.;Carbone, David P.
这项研究使用行政索赔数据对8979名计算机断层扫描异常的患者进行了肺癌诊断的成本评估。在没有随后的肺癌诊断的患者中，活检和活检相关的不良事件大大增加了肺癌的诊断评估成本，这表明需要额外的风险分层来减少不必要的活检。目的：评估在CT扫描异常的患者中导致肺癌诊断的诊断成本。患者和方法：使用5%的医疗保险索赔数据(2009年1月1日至2011年12月31日)进行了一项回溯性队列研究。确定了年龄在65岁到74岁之间的胸部CT扫描异常的患者。以胸部CT扫描异常的日期为指标。经过12个月的随访后评估的结果包括肺癌诊断率和肺癌诊断后的后续诊断测试的使用和相关费用。结果：8979例胸部CT扫描异常患者(平均年龄69.3±-2.9岁)中，13.9%的患者被诊断为12个月以上肺癌。胸部X光是最常见的诊断方法。在接受活组织检查的19%的人中，43.6%的人在随访期间没有被诊断为肺癌。患有肺癌的患者的平均总诊断评估成本高于未患肺癌的患者(7567美元对3558美元)。在未被诊断为肺癌的患者中，接受活检的患者的平均诊断成本与未接受活检的患者的诊断成本中值相似，高出28倍。不良事件显著增加了每次活检的平均成本(约4倍)。结论：在确定的研究样本中，肺癌诊断总成本为3830万美元，其中43.1%来自未诊断为肺癌的活检患者。需要额外的风险分层，以减少不必要的活检转诊和成本。此外，不良事件显著增加了成本。
This study assessed the costs leading up to a lung cancer diagnosis in 8979 patients with an abnormal computed tomography scan using administrative claims data. Biopsies among patients without a subsequent lung cancer diagnosis and biopsy-related adverse events contribute significantly to the diagnostic assessment costs of lung cancer, suggesting the need for additional risk stratification to decrease unnecessary biopsies.Purpose: To assess the diagnostic costs leading up to a lung cancer diagnosis in patients with abnormal computed tomography (CT) scans. Patients and Methods: A retrospective cohort study using the 5% Medicare claims data (January 1, 2009, to December 31, 2011) was conducted. Patients aged 65 to 74 years with an abnormal chest CT scan were identified. Index was defined as the date of the abnormal chest CT scan. Outcomes assessed over a 12-month follow-up after index included lung cancer diagnosis rate and the use and associated costs of follow-up diagnostic tests up to diagnosis of lung cancer. Results: Of 8979 patients identified with an abnormal chest CT scan (mean age, 69.3 +/- 2.9 years), 13.9% were diagnosed with lung cancer over 12 months. Chest x-rays were the most common diagnostic test. Of the 19% who underwent a biopsy, 43.6% were not diagnosed with lung cancer during follow-up. The average total diagnostic assessment cost per patient was higher for those with versus without lung cancer ($7567 vs. $3558). Among patients not diagnosed with lung cancer, the median diagnostic cost per patient for those with versus without biopsy was similar to 28 times higher. Adverse events significantly increased the average cost per biopsy (approximately 4-fold). Conclusion: Total lung cancer diagnostic cost was $38.3M in the defined study sample, of which 43.1% was accounted for by biopsied patients without a lung cancer diagnosis. Additional risk stratification is required to decrease unnecessary biopsy referrals and costs. Further, adverse events significantly increased costs.