Abstract
This study aimed to estimate the downstream complications and healthcare expenditure after invasive procedures for lung lesions, which in turn could be used for future cost-effectiveness analyses of lung cancer screening in Taiwan. We interlinked the Taiwan National Beneficiary Registry with the National Health Insurance Reimbursement databases to identify non-lung cancer individuals aged 50–80 years who underwent invasive lung procedures within one month after non-contrast chest computed tomography between 2014 and 2016. We directly matched one individual with 10 controls by age, gender, calendar year, residence area, comorbidities, and the past one-year healthcare expenditure to calculate incremental one-month complication rates and attributable costs. A total of 5805 individuals who underwent invasive lung procedures were identified and matched with 58,050 controls. The incremental one-month complication rates were 13.4% (95% CI: 10.9% to 15.8%), 10.7% (95% CI: 9.2% to 12.1%), and 4.4% (95% CI: 2.0% to 6.7%) for thoracic surgery, bronchoscopy, and needle biopsy, respectively. The incremental one-month healthcare expenditure for minor, intermediate, and major complications were NT$1493 (95% CI: NT$-3107 to NT$6092), NT$18,422 (95% CI: NT$13,755 to NT$23,089), and NT$58,021 (95% CI: NT$46,114 to NT$69,929), respectively. Individuals aged 60–64 years incurred the highest incremental costs. Downstream complications and the healthcare expenditure after invasive procedures for lung lesions would be substantial for non-lung cancer individuals 50–80 years of age. These estimates could be used in modeling the cost-effectiveness of the national lung screening program in Taiwan.
Highlights
Low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality among high-risk populations [1,2]
One of the drawbacks of lung cancer screening is its high rate of falsepositive results [1,5], which brings about unnecessary invasive lung procedures, including thoracic surgery, bronchoscopy, and needle biopsy
31,217 individuals underwent at least one invasive lung procedure, and subjects received the procedures within one month following non-contrast chest
Summary
Low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality among high-risk populations [1,2]. The evolving evidence, guidelines, and policies have increased the use of chest computed tomography (CT) for lung cancer screening [3,4]. One of the drawbacks of lung cancer screening is its high rate of falsepositive results [1,5], which brings about unnecessary invasive lung procedures, including thoracic surgery, bronchoscopy, and needle biopsy. In Taiwan, for example, a 6.1-fold increase of CT-guided needle biopsies was noted within 10 years [6]. The Taiwan National Lung Screening Program among high-risk participants who have never smoked began in 2014 and ended its enrollment in 2019 [7], with the results being
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