OBJECTIVES

Over the last few decades, dynamic changes in the payer landscape have resulted in increasing patient responsible out-of-pocket costs (PROOPC). As such, little is known about these types of costs for patients undergoing diagnostic biopsy for suspicious pulmonary nodules in the U.S. This study seeks to describe the spectrum of PROOPC for diagnostic tissue sampling for suspicious pulmonary nodule with an ultimate diagnosis of lung cancer.

METHODS

Retrospective cohort study of patients who underwent diagnostic biopsy for suspicious pulmonary nodule utilizing IBM Watson U.S. MarketScan Database (2013 to 2017). Claims data included both total hospital and physician billed costs, insurer reimbursement and PROOPC. PROOPC were further stratified by type of biopsy, whether the patient underwent a single or multiple biopsies, and year of biopsy.

RESULTS

A total of 22,870 patients age 18-95 who underwent diagnostic lung biopsy were identified after excluding patients who changed coverage six months before or after diagnosis. The gender ratio was 49 to51 for female;male, and 50% of patients were aged 65 or above. 78% of patients had a comorbidity. The median PROOPC for a patient receiving a single biopsy (any type) was $591, two biopsies: $696, three biopsies: $797, four biopsies: $1163. By biopsy type, the median PROOPC for a patient requiring a single biopsy was $594 for percutaneous biopsy, $315 for surgical biopsy, $664 for bronchoscopic biopsy, and $522 for mediastinoscopic biopsy. From 2013 to 2017, PROOPC did not appear to increase.

CONCLUSIONS

The median PROOPC for lung cancer patient requiring a single diagnostic lung biopsy is $591. Prior research indicates that almost 50% of the lung cancer patient population undergoes multiple biopsies increasing PROOPC anywhere between 20-100% resulting in further patient financial burden for each episodic biopsy attempt. Further cost effectiveness research is needed to determine various technologies and their effectiveness on insurer reimbursement and PROOPC.