OBJECTIVES: Identification and workup of pulmonary nodules (PNs) can be essential to early diagnosis and management of non-small cell lung cancer (NSCLC). Clinical management of PNs is often guided by physician judgement or a quantitative risk model coupled with threshold-based decision making. Most often the patient’s nodule risk category is low to moderate where further evaluation is required and guidelines are unclear. In these scenarios, a blood-based auto-antibody (AAb) test may be utilized to help up-classify the risk of malignancy to better inform management and treatment decisions. This study aimed to estimate the budget impact of a blood-based AAb test from a US commercial payer perspective.

METHODS: A budget impact model was developed to evaluate the use of a blood-based AAb test within a hypothetical 1 million-member US commercial health plan over a 2-year time horizon. Blood-based AAb test use within a payer system was compared to standard of care without the test. Model inputs included stage shifts in NSCLC, procedures associated with PNs and NSCLC, 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 AAb test, there is an estimated savings of $626,251 over 2 years. The incremental cost per-member per-month (PMPM) is -$0.052.

CONCLUSIONS: The model results indicate that the use of a blood-based AAb 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.