Chiu Yu-Wen, Kao Yu-Hsiang, Simoff Michael J, Ost David E, Wagner Oliver, Lavin James, Culbertson Richard A, Smith Dean G
Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Clinicoecon Outcomes Res. 2021 Mar 17;13:191-200. doi: 10.2147/CEOR.S295494. eCollection 2021.
To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer.
Observational study using data from IBM Marketscan Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies.
The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40-80%. Complications account for 13% of total costs.
Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs.
描述肺癌患者诊断程序的分布、并发症发生率及活检的总成本。
采用IBM Marketscan数据库中的数据进行观察性研究，纳入2013年7月至2017年6月期间连续参保的成年原发性肺癌诊断和治疗患者。肺癌诊断成本涵盖索引活检前6个月至治疗期间。胸部CT扫描、活检及术后并发症的成本根据总支付金额估算。住院期间附带的活检成本通过可比的门诊活检估算。
该数据库包括22870例患者，共进行了37160次活检，其中经皮活检16009次（43.1%），支气管镜活检14997次（40.4%），手术活检4072次（11.0%），纵隔镜活检2082次（5.6%）。41.9%的患者进行了多次活检。仅接受一种活检类型的患者中，最常见的并发症为气胸（1304例患者，8.4%）、出血（744例患者，4.8%）和插管（400例患者，2.6%）。然而，大多数并发症无需增加成本的干预措施。住院手术活检的中位总成本最高（29988美元），门诊经皮活检的中位总成本最低（1028美元）。同一类型的重复活检使成本增加40 - 80%。并发症占总成本的13%。
确诊肺癌活检的成本因活检类型和环境而异。多次活检、住院手术及并发症会导致更高的成本。
