OBJECTIVES: Timely workup of pulmonary nodules (PNs) can be essential to early diagnosis and management of non-small cell lung cancer (NSCLC). Among PNs, clinical management is often guided by quantitative risk models coupled with threshold-based decision making and physician judgement. Patient’s nodules are often in a “low to moderate risk” category where guidelines are unclear for next steps. These PNs are frequently sent for invasive interventions only to be identified as benign. A blood-based integrated classifier (IC) can be utilized for PNs to reclassify nodules that are “likely benign” and avoid unnecessary interventions and complications. This study aimed to estimate the economic impact of a blood-based IC for PN risk assessment from a US commercial payer perspective.

METHODS: A budget impact model was developed to evaluate use of a blood-based IC test within a hypothetical 1 million-member US commercial health plan over a 2-year horizon. Blood-based IC test use within a payer system was compared to standard of care without the test. Model inputs included stage shifts in NSCLC, procedures costs, and downstream treatment costs associated with NSCLC.

RESULTS: In a hypothetical commercial health plan of 1 million members without the blood-based auto-antibody test, an estimated 280 patients would undergo invasive procedure to characterize their PN with approximately 181 identified as benign. An estimated $30,994,431 would be spent on nodule workup, invasive procedures, and cancer treatments. In the scenario with the blood-based IC test, it is estimated that there would be a 35.2% reduction in invasive procedures and an estimated savings of $463,898 over 2 years. The incremental cost PMPM is -$0.039.

CONCLUSIONS: The model results indicate that the use of a blood-based IC test for patients with pulmonary nodules would likely result in a minimal budget impact, or true cost savings, from a US commercial health plan perspective.