OBJECTIVES: An estimated 1.57 million pulmonary nodules (PNs) are detected annually in the US, a number that is increasing with more imaging and screening programs.¹ Amongst these PNs, approximately 80% are initially categorized as low to moderate risk² where many delays in cancer diagnosis occur. Workup of PNs can be essential to early diagnosis and management of non-small cell lung cancer (NSCLC). In these scenarios, a blood-based auto-antibody (AAb) test may be utilized to up-classify risk of malignancy to better inform management and treatment decisions. This study aimed to estimate the budget impact of a AAb test from a US Medicare payer perspective.

METHODS: A budget impact model was developed to evaluate the use of a AAb test within a hypothetical 1 million-member US Medicare health plan over a 2-year time horizon. AAb test use within a Medicare 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 Medicare plan of 1 million members without the AAb test, an estimated 1,701 patients would undergo invasive procedure to characterize their PN with approximately 1,102 identified as benign. An estimated $188,335,223 would be spent on PN workup, invasive procedures, and cancer treatments. In the scenario with the AAb test, that there would be an estimated savings of $3,909,603 over 2 years. The incremental cost PMPM is -$0.326.

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 Medicare health plan perspective.