OBJECTIVES: Among patients with suspected lung cancer nodules, novel robotic-assisted bronchoscopy methods may offer improved diagnostic yields. This could improve access to curative treatments for patients and downstream treatment revenue for hospitals, despite the higher upfront cost of a bronchoscopic biopsy compared to percutaneous biopsy methods.

METHODS: We used the Premier Healthcare Database, which contains patient-level data from approximately 20-25% of all hospital discharges in the United States. Using both CPT codes and billing records, we identified patients who received either a percutaneous transthoracic needle aspiration (TTNA) or a shape-sensing robotic-assisted bronchoscopy (RAB) biopsy from 2020-2022. We then followed the biopsy patients post-procedurally to identify malignant lung cancer diagnoses and receipt of any lung cancer treatments, including chemotherapy, immunotherapy, radiotherapy, and/or a surgical resection (e.g. lobectomy or segmentectomy). Using Medicare reimbursement rates of the treatment procedures, we estimated facility and physician revenue for hospitals, comparing 2,000 hypothetical patients allocated evenly between RAB and TTNA biopsies.

RESULTS: Among 159,961 patients receiving a biopsy, 2.8% (n=4,337) underwent an RAB and 97.2% (n=152,594) underwent TTNA. 62% of RAB patients vs 52% of TTNA patients had a diagnostic result with a malignant pathology. 38% of RAB malignancies and 27% of TTNA malignancies received cancer treatment in the database. Surgery (27.9%) or radiotherapy (27.4%) were the most common treatment approaches, with surgery and radiotherapy occurring 2.3x and 1.4x more often among RAB patients vs. TTNA patients. Among 1,000 hypothetical RAB patients, 23% would receive treatment leading to $3,105,920 in reimbursements. Among 1,000 hypothetical TTNA patients, 14% would receive treatment leading to $1,417,820 in reimbursements.

CONCLUSIONS: While RAB is associated with higher costs during the biopsy encounter compared to TTNA, the downstream revenue attributable to the treatment of lung cancer is markedly higher among RAB patients.