Health Economics of Biopsy for Suspected Lung Cancer

Intuitive presents three Health Economics and Outcomes Research (HEOR) studies describing the current landscape of biopsies for lung cancer. See results that quantify biopsy frequency, delays, complications, and associated costs on the path to lung cancer diagnosis.

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  1. Zhang Y, Shi L, Simoff MJ, J Wagner O, Lavin J. Biopsy frequency and complications among lung cancer patients in the United States. Lung Cancer Manag. 2020;9(4):LMT40. Published 2020 Aug 17. doi:10.2217/lmt-2020-0022. https://www.futuremedicine.com/doi/full/10.2217/lmt-2020-0022

  2. Study limitations

    • The MarketScan claims data come mostly from large employers providing coverage for their employees and dependents. Thus, the results may not be generalizable to the population as a whole.
    • The analytic files are based on payors who submit claims data and may not be representative of certain regions or the entire country.
    • A single primary diagnosis of lung cancer was used as evidence of lung cancer and did not have a confirmed pathological diagnosis of cancer as no chart extraction was used for this evaluation or for the records included in the analysis.
    • There are also limitations when defining an episode of care for analysis. The analysis focused on a 12 month episode of care; therefore, the biopsy procedure performed could have been for a re occurrence of disease, thus affecting the purpose of the biopsy, especially in a patient with suspected late stage disease.

  3. Zhang, Y., Simoff, M.J., Ost, D. et al. Understanding the patient journey to diagnosis of lung cancer. BMC Cancer 21, 402 (2021). https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-08067-1

  4. Study limitations

    • This is a retrospective study that is associated with confounding factors for biopsies and treatment procedures.
    • The patient population comes from two Louisiana healthcare systems and the patient pathways from nodule identification to diagnosis may not be generalizable to other healthcare systems throughout the country.
    • Linking of data from REACHnet with the Louisiana Tumor Registry resulted in many patients being excluded from the final cohort per protocol.
    • Results may not be generalizable to patient populations outside of Louisiana healthcare systems.

  5. Chiu YW, Kao YH, Simoff MJ, Ost DE, Wagner O, Lavin J, Culbertson RA, Smith DG. Costs of Biopsy and Complications in Patients with Lung Cancer. Clinicoecon Outcomes Res. 2021 Mar 17;13:191-200. doi: 10.2147/CEOR.S295494. PMID: 33762834; PMCID: PMC7982449. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982449/

  6. Study limitations

    • The study population does not include persons who are uninsured, publically insured other than by Medicare, or persons without continuous enrollment.
    • Claims data are focused on administrative rather than clinical information (i.e. staging information).
    • 30% of those diagnosed with lung cancer in the IBM Marketscan Database did not have continuous insurance enrollment, which is typically indicative of a change in employment status or a company’s change in insurance provider.
    • This study likely excludes low income individuals and may not be generalizable to the broader U.S. population.
    • Many patients, 5434 (19.2%), were observed to have lung cancer therapy with no evidence of biopsy.
    • A single diagnosis of lung cancer in the primary diagnosis position was used as evidence of lung cancer, however, claims data does not provide a pathological diagnosis of lung cancer.
    • While authors attempted to separate diagnosis and treatment claims, they may have included some costs associated with treatments if claims for diagnosis and treatments were combined. This is particularly a concern for patients with inpatient admissions.
    • This analysis also excluded patients who received multiple biopsy types, a population subset that may have more complications, limiting the scope of the analysis.
    • Complications (excluding prolonged air leak and abscess of the lung) were only considered to be biopsy related if they occurred within a day immediately following the biopsy, which may underrepresent the complication rates.