Pulmonary Nodule (PN)-Related and Lung Cancer-Related Workup Costs Within the Two-Year Period After Diagnosis of a PN in the United States
Author(s)
Kimberly Le, MBA, MS, PharmD1, Jonathan Scott Kurman, MD, MBA2, Michelle Jerry, MS3, Megan Richards, MPH, PhD3.
1Director of HEOR, Biodesix, spring hill, FL, USA, 2Froedtert Hospital, Milwaukee, WI, USA, 3Merative, Ann Arbor, MI, USA.
1Director of HEOR, Biodesix, spring hill, FL, USA, 2Froedtert Hospital, Milwaukee, WI, USA, 3Merative, Ann Arbor, MI, USA.
OBJECTIVES: To characterize the PN-related and lung-cancer related workup costs of patients with PNs within a two-year period after diagnosis of a solitary PN in the United States.
METHODS: This retrospective study of patients newly-diagnosed with PNs used data from MarketScan® Commercial and Medicare Databases from 1/1/2013-12/31/2019. Adult patients with a diagnosis of solitary PN (ICD-10: R91.1) between 1/1/2015-12/31/2017 (index date), 24 months of continuous enrollment before and after index date, and no claims for PN or cancer in pre-index period were included. Mean and median PN-related and workup costs (overall and by workup type) were reported.
RESULTS: Among patients diagnosed with a new solitary PN (N=61,546), PN-related medical costs during the two years after diagnosis averaged $9,485 ($4,900 for inpatient services, $281 for ER visits, $386 for outpatient office visits, and $3,918 for other outpatient services). Among patients who had workup (N=22,801), the average total cost for workup during the 24-month follow-up period was $2,455 (median $354). The majority of these costs were payer plan-paid ($2,312) with only a small portion being paid out-of-pocket by the patient ($143). For patients with the given type of workup, workup costs were highest for surgical resections ($35,686), followed by non-surgical biopsies ($5,207), PET scans ($1,668), and CT scans ($482).
CONCLUSIONS: While much literature is published on the costs of treatment of lung cancer, not much in the literature has been identified related to PN costs in the period immediately following PN diagnosis. Procedures for PNs are expensive while imaging is much less costly. Strategies to identify the right candidates for biopsy and surgery may help to mitigate healthcare costs.
METHODS: This retrospective study of patients newly-diagnosed with PNs used data from MarketScan® Commercial and Medicare Databases from 1/1/2013-12/31/2019. Adult patients with a diagnosis of solitary PN (ICD-10: R91.1) between 1/1/2015-12/31/2017 (index date), 24 months of continuous enrollment before and after index date, and no claims for PN or cancer in pre-index period were included. Mean and median PN-related and workup costs (overall and by workup type) were reported.
RESULTS: Among patients diagnosed with a new solitary PN (N=61,546), PN-related medical costs during the two years after diagnosis averaged $9,485 ($4,900 for inpatient services, $281 for ER visits, $386 for outpatient office visits, and $3,918 for other outpatient services). Among patients who had workup (N=22,801), the average total cost for workup during the 24-month follow-up period was $2,455 (median $354). The majority of these costs were payer plan-paid ($2,312) with only a small portion being paid out-of-pocket by the patient ($143). For patients with the given type of workup, workup costs were highest for surgical resections ($35,686), followed by non-surgical biopsies ($5,207), PET scans ($1,668), and CT scans ($482).
CONCLUSIONS: While much literature is published on the costs of treatment of lung cancer, not much in the literature has been identified related to PN costs in the period immediately following PN diagnosis. Procedures for PNs are expensive while imaging is much less costly. Strategies to identify the right candidates for biopsy and surgery may help to mitigate healthcare costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PT5
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)