Healthcare use after screening for lung cancer

Abstract

To evaluate the benefits of lung cancer screening, all effects of screening need to be considered. The aim of this study was to determine whether screening had an effect on healthcare use, specifically whether use increased for those with a false-positive or indeterminate screening result. Recruited were 400 individuals participating in a lung cancer screening study at the University of Pittsburgh. Self-reported outpatient healthcare use information was collected for the 6 months before, 0 to 6 months after, and 6 to 12 months after screening. The screening outcomes were negative, indeterminate, and suspicious. Repeated-measures Poisson regression models were used to examine changes in use over time and how changes over time varied among the screening outcome groups. Approximately 58% of participants had a negative screening result, 36% had an indeterminate result, and approximately 6% had a suspicious result. The percentage of individuals who had any incidence of each type of outpatient use increased after screening, with the greatest increase noted for those with a suspicious screening result. Adjusted mean use significantly increased for nearly all types of use and for all 3 screening results categories in the 6 months after screening, but mostly declined to prescreening levels in the next 6 months. Outpatient healthcare use was found to increase after screening for all individuals who were screened for lung cancer, regardless of the screening finding. The cost of the lung-related visits alone was substantial. Therefore, if lung cancer screening prevalence is increased, attendant follow-up healthcare costs are also likely to increase.