OBJECTIVES: Diagnostic work up for lung cancer has high rates of repeat biopsies and associated complications causing increased economic burden. This research analyzed the costs associated with different diagnostic approaches and complications.

METHODS: Patient-level de-identified records of commercial and Medicare insurance claims from IBM MarketScan^® included patients 18 years and older who had continuous health plan enrollment between July 1, 2013 and June 30, 2017, at least one biopsy and a primary diagnosis of lung cancer. Patients had lung cancer treatment, defined by Current Procedural Terminology (CPT), ICD-9-CM or ICD-10-CM procedure codes. Costs from payer and patient perspectives were included in the analyses. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments by payers and patient as reported in the claims data. Costs for capitated arrangements were estimated using payment proxies that were computed based on average paid claims. Costs of biopsy included both procedure and physician costs in outpatient setting. Biopsies performed in the inpatient setting included all costs during the entire hospital stay for that biopsy, inclusive of complications and were reported by care setting and by procedure. All costs were normalized to 2017 US dollars using the Bureau of Labor Statistics’ Consumer Price Index Medical Care Component.

RESULTS: Median costs were highest for surgical ($28,487.94; 95% CI: $1095.90 to $126,280.26) and lowest for percutaneous ($1,462.65; 95% CI: $111.21 to $61,481.79) procedures. Inpatient costs were 4-10 fold higher than outpatient costs for percutaneous and bronchoscopic procedures. Those receiving multiple percutaneous or bronchoscopic biopsies had costs 2-3 fold higher than those with only one biopsy.

CONCLUSIONS: Median costs of lung cancer diagnosis ranged from $1024.21 to $48,332.88 and varied substantially by procedure and setting of care. Multiple diagnostic procedures increased median cost by as much as a factor of three.