PMD7 - Biopsy Procedures in Patients with Primary Lung Cancer

Abstract

Biopsy is critical in diagnosis and staging of lung cancer. The study aims to assess the use of biopsy procedures, including the approaches, the frequency, and the associated costs, in the care pathway of diagnosis or monitoring of lung cancer. This study used Truven MarketScan® Database from 2013 to 2015. The 2014 data was used to identify baseline patients with primary diagnosis of lung cancer. We included patients who were ≥18 years old, had continuous enrollment of 12 months before and after the first recorded primary lung cancer diagnosis dated in 2014, and had ≥2 primary lung cancer diagnoses within two months. CPT, ICD-9-CM, and ICD-10-PCS codes were used to capture lung cancer diagnosis and biopsy procedures. The radiologic procedures (e.g. ultrasound, fluoroscopic, CT, or MR) for needle placement were excluded from biopsy enumeration. We identified three major biopsy approaches: surgical, percutaneous, and bronchoscopic. Descriptive statistics of frequency, duration and costs were performed for biopsies within a year before and after the primary diagnosis. Among 22,161 patients included in 2014, 14,280 (64.44%) patients had ≥1 biopsies within 1 year before or after the primary diagnosis; 17.59% surgical, 41.57% percutaneous, and 33.93% bronchoscopic. Specifically, 2,905 (13.11%) patients had 1 biopsy with an average procedure cost of $5,489 (standard deviation (SD): $22,593); 4,625 (20.87%) patients had 2 biopsies, with an average of 15.7 days from the first biopsy and an average procedure cost of $7,729 (SD: $4,664); and 6,750 (30.46%) patients had ≥3 biopsies with an average of 22.7 days between biopsies and an average procedure cost of $11,899 (SD: $15,438). All costs were significantly different (p<0.0001). More than 50% of patients with primary lung cancer had multiple biopsies with high costs in short time frame. Further research is needed to identify ways to reduce unnecessary biopsies.