Lung cancer diagnostic workups correlate with unnecessary biopsies

A study of the utilization rates and estimated Medicare costs of lung cancer diagnostic workups in patients who had abnormal CT scans shows that nearly half of the costs were attributed to biopsies that ultimately proved to be negative for lung cancer.

The study was presented last week at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. Led by Tasneem Lokhandwala, M.S., Ph.D., a data analyst at Palm Harbor, Florida-based Xcenda, an AmerisourceBergen company, the study used a 5 percent sample of Medicare beneficiaries from Jan. 1, 2009, through Dec. 31, 2011. From that sample, 8,979 eligible patients were identified who were 65 to 74 years old with an abnormal chest CT scan between July 1, 2009, and Dec. 31, 2010.

Diagnostic tests used until a patient was diagnosed with lung cancer included chest CT scans, chest X-rays, lung biopsies and PET scans. The researchers found lung biopsies were performed on 1,742 patients (19.4 percent) and that 43.7 percent of those biopsies ended up being negative.

The researchers calculated the associated Medicare procedure costs for each of the diagnostic tests used on these patients, including physician costs, anesthesia services and adverse event costs. They determined that for those patients diagnosed with lung cancer, the average total cost of the diagnostic workup was $7,567, while the average total cost for those patients not diagnosed with lung cancer was $3,558. The median cost of each biopsy was $3,784 with a mean cost of $14,634. The average of biopsies with complications was four times higher than biopsies without complications.

Furthermore, the researchers found that many of these negative biopsies were performed unnecessarily. According to the study, National Comprehensive Cancer Network lung cancer screening guidelines--which call for low-dose CT of the chest followed by a PET scan to identify patients for biopsy--were not followed, leading to many patients being unnecessarily biopsied.

"This study provides a baseline of current costs for the lung cancer diagnostic workup prior to the introduction of major lung cancer screening programs. Biopsy costs comprise a significant proportion of the overall cost of diagnosing lung cancer," Lokhandwala said in an announcement. "These results suggest that since NCCN guidelines are not being followed, there is a need to develop more precise risk stratification tools to better identify patients who require lung biopsies. Reducing the number of patients who are referred for lung biopsies has the potential to decrease Medicare costs and ultimately improve patient outcomes."

Of course, concerns about the risks and costs associated with lung cancer diagnostic workups--such as unnecessary biopsies--was one of the reasons mentioned by panelists on the MEDCAC (Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) for recommending against Medicare coverage for CT lung cancer screening last April.

To learn more:
- read about the study (.pdf)
- see the announcement