Complication Rates and Downstream Medical Costs Associated With Invasive Diagnostic Procedures for Lung Abnormalities in the Community Setting

Abstract

Services added lung cancer screening with low-dose computed tomography (LDCT) as a Medicare preventive service benefit in 2015 following findings from the National Lung Screening Trial (NLST) that showed a 16% reduction in lung cancer mortality associated with LDCT. A challenge in developing and promoting a national lung cancer screening program is the high false-positive rate of LDCT because abnormal findings from thoracic imaging often trigger subsequent invasive diagnostic procedures and could lead to postprocedural complications. OBJECTIVE To determine the complication rates and downstream medical costs associated with invasive diagnostic procedures performed for identification of lung abnormalities in the community setting. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of non-protocol-driven community practices captured in MarketScan Commercial Claims & Encounters and Medicare supplemental databases was conducted. A nationally representative sample of 344 510 patients aged 55 to 77 years who underwent invasive diagnostic procedures between 2008 and 2013 was included. MAIN OUTCOMES AND MEASURES One-year complication rates were calculated for 4 groups of invasive diagnostic procedures. The complication rates and costs were further stratified by age group. RESULTS Of the 344 510 individuals aged 55 to 77 years included in the study, 174 702 comprised the study group (109 363 [62.6%] women) and 169 808 served as the control group (106 007 [62.4%] women). The estimated complication rate was 22.2% (95% CI, 21.7%-22.7%) for individuals in the young age group and 23.8% (95% CI, 23.0%-24.6%) for those in the Medicare group; the rates were approximately twice as high as those reported in the NLST (9.

Low Rates of Patient-Reported Physician–Patient Discussion about Lung Cancer Screening among Current Smokers: Data from Health Information National Trends Survey

“…The present study brought up a similar issue of concern on the spillover effect of lung cancer screening that never smokers or smokers of ineligible age also expressed interest in lung cancer screening. Some of these patients who underwent lung cancer screening would receive invasive diagnostic procedures and would thus be exposed to the risks of post-procedural complications and related costs (18). Our finding highlights the importance of shared decision-making: Most of this discussion among the ineligible population, including ages less than 55, older than 77, or never smokers, should emphasize the harms of pursuing lung cancer screening and increased awareness of lung cancer screening among these individuals to prevent unwarranted use.…”

Improving lung cancer diagnosis by combining exhaled-breath data and clinical parameters

“…First, in the case of implementation of LDCT in Europe, the Aeonose may be deployed after suspicion of lung cancer has been raised with LDCT. Due to the high NPV with the Aeonose, subjects could be prevented from undergoing unnecessary invasive interventions and be monitored with prolonged intervals [8]. In addition, there is current debate about identifying at-risk groups relevant for LDCT screening [34][35][36].…”

“…Currently, the only screening method leading to reduced lung cancer mortality in high-risk groups is annual low-dose computed tomography (LDCT) [4,5]. However, LDCT screening for lung cancer has also resulted in a notable rate of false-positive cases, leading to unnecessary invasive procedures, risks due to radiation exposure and unnecessary anxiety [4][5][6][7][8]. In Europe, results of the Dutch-Belgian lung cancer screening trial (NELSON) are awaited before a decision on implementation of screening programmes in Europe will be made [9].…”

Evaluation of the Informational Content and Readability of US Lung Cancer Screening Program Websites

“…34 As part of the Affordable Care Act, LCS is covered by the CMS and private insurance plans, but additional costs as a result of screening, such as travel cost, wage loss, and follow-up procedures, can also encumber and possibly dissuade LCS-eligible persons. 35 Although cost of LCS was mentioned on 75% (192 of 257) of websites, only 51% (131 of 257) mentioned coverage by Medicare or private insurance. Only 7% (17 of 257) of websites described out-of-pocket expenses.…”