Abstract
BackgroundA recent study estimated that more than 1.5 million Americans have an indeterminate pulmonary nodule (IPN) identified on a chest computed tomography (CT) scan each year outside of lung cancer screening programs. However, the cost and pattern of subsequent IPN workup have not been described for real-world settings.ObjectivesTo examine the pattern and cost of IPN workup in real-world practice using insurer administrative claims data for commercially-insured individuals.MethodsThe primary source for this retrospective observational study was the MarketScan® 2013–2016 databases, which include information on 28 to 47 million insured lives. The newly diagnosed IPN study population consisted of members with an IPN diagnosis code on a claim in 2014 who did not have prior diagnosis of an IPN or lung cancer in 2013 and who had coverage from 2014 to 2016. Subsequent claims were examined for workups included in the American College of Chest Physicians (ACCP) guideline recommendations and the costs of workup were tabulated.ResultsOf the 15 064 patients in the study population, only 5471 (36%) received any subsequent workup. The average and median costs of workup for these patients were $3270 and $2068, respectively. Spread across the commercially-insured population, the workup is estimated to cost between $1 and $2 per member per year.ConclusionsThe majority of commercially-insured members with newly identified IPNs do not appear to have any guideline-recommended workup, despite a low incremental cost of such workup services on a population basis.
Highlights
A recent study estimated that more than 1.5 million Americans have an indeterminate pulmonary nodule (IPN) identified on a chest computed tomography (CT) scan each year outside of lung cancer screening programs
A recent study estimated that more than 1.5 million Americans have an IPN identified on a chest CT scan each year, not counting IPNs identified through lung cancer screening.[2]
Two findings stand out from our analysis: the majority of individuals in the study group of patients with newly identified IPNs did not have any workup as specified in the American College of Chest Physicians (ACCP) guidelines, and the cost of IPN workups is low when considered on a population basis
Summary
A recent study estimated that more than 1.5 million Americans have an indeterminate pulmonary nodule (IPN) identified on a chest computed tomography (CT) scan each year outside of lung cancer screening programs. Subsequent claims were examined for workups included in the American College of Chest Physicians (ACCP) guideline recommendations and the costs of workup were tabulated. Conclusions: The majority of commercially-insured members with newly identified IPNs do not appear to have any guideline-recommended workup, despite a low incremental cost of such workup services on a population basis. A recent study estimated that more than 1.5 million Americans have an IPN identified on a chest CT scan each year, not counting IPNs identified through lung cancer screening.[2] This study examines the workup pattern of a large sample of these patients covered by commercial insurance. Of the 1.5 million identified IPNs each year, approximately 63 000 (4%) are estimated to receive a diagnosis of lung cancer within 2 years
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