Director, Cardiothoracic Radiology Fellowship and Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
Department of Obstetrics and Gynecology, University of Michigan Health, Ann Arbor, Michigan.
J Am Coll Radiol. 2022 Jan;19(1 Pt A):35-46. doi: 10.1016/j.jacr.2021.09.015. Epub 2021 Oct 1.
Consequences of lung cancer screening (LCS) with low-dose chest CT in clinical settings, including procedures, costs, and complications, are incompletely understood. We evaluated downstream invasive procedures after LCS, total and out-of-pocket (OOP) costs of these procedures, and correlates of procedural rates and costs.
Using the Clinformatics Data Mart, we retrospectively included patients between ages 55 and 79 years receiving LCS between 2015 and 2017. The types and frequency of downstream invasive procedures (including needle biopsy, bronchoscopy, surgery, and cytology) were described. Treating the LCS examination and downstream procedures as a single LCS episode, we described the per-episode total costs (insurance reimbursement + OOP costs of LCS and downstream procedures) and OOP costs. Correlates of costs were determined using linear and logistic regression.
A total of 6,268 patients received at least one low-dose chest CT; 462 patients (7.4%) received at least one procedure within 12 months after LCS (needle biopsy 69.0%, cytology 23.6%, bronchoscopy 18.6%, surgery 23.8%). Women and patients ≥65 years were more likely to receive a downstream procedure. Ninety-three patients (20.1%) were diagnosed with lung cancer after LCS. The total cost of managing this population of lung screeners was $5,060,511.04, with an average per-episode total cost of $740.06. The aggregate OOP costs to this population of lung screeners was $427,069.74, with an average per-episode OOP cost of $62.46.
Rates of invasive procedures after LCS in a commercially insured population exceeded those of clinical trials. Considering LCS and associated downstream procedures as an episode of care results in modest OOP cost.
在临床环境中，肺癌筛查（LCS）使用低剂量胸部 CT 的后果，包括程序、成本和并发症，尚不完全清楚。我们评估了 LCS 后的下游侵入性程序、这些程序的总费用和自付费用（OOP），以及程序率和费用的相关性。
使用 Clinformatics Data Mart，我们回顾性地纳入了 2015 年至 2017 年间接受 LCS 的年龄在 55 岁至 79 岁之间的患者。描述了下游侵入性程序（包括针吸活检、支气管镜检查、手术和细胞学）的类型和频率。将 LCS 检查和下游程序视为单个 LCS 事件，我们描述了每个事件的总费用（保险报销+LCS 和下游程序的 OOP 费用）和 OOP 费用。使用线性和逻辑回归确定成本的相关性。
共有 6268 名患者接受了至少一次低剂量胸部 CT；462 名患者（7.4%）在 LCS 后 12 个月内接受了至少一次程序（针吸活检 69.0%、细胞学 23.6%、支气管镜检查 18.6%、手术 23.8%）。女性和≥65 岁的患者更有可能接受下游程序。93 名患者（20.1%）在 LCS 后被诊断为肺癌。管理这群肺癌筛查者的总费用为 5060511.04 美元，平均每个事件的总费用为 740.06 美元。这群肺癌筛查者的总 OOP 费用为 427069.74 美元，平均每个事件的 OOP 费用为 62.46 美元。
在商业保险人群中，LCS 后的侵入性程序率高于临床试验。将 LCS 及相关下游程序视为一个治疗周期会导致适度的 OOP 费用。
