© 2021 MJH Life Sciences and Oncology Nursing News. all rights reserved.

© 2021 MJH Life Sciences™ and Oncology Care News. all rights reserved.

Within 12 months after lung cancer screening, a total of 7.4% of patients underwent a second or downstream operation.

According to a study published in the American Journal of Radiology, adults whose insurance covers lung cancer screening are more likely to undergo invasive screening procedures than patients in clinical trials. However, out-of-pocket costs associated with downstream procedures may prevent adults with abnormal results from undergoing follow-up testing.

Of the 6,268 national employer insurance adults who received at least one low-dose CT scan (LDCT), 462 (7.4%) had a second or downstream operation within 12 months after the screening. Women (adjusted odds ratio) [aOR], 0.82; 95% CI, 0.68-0.99) and adults over 65 years of age (aOR, 1.62; 95% CI, 1.28-2.04) are more likely to follow up with downstream surgery .

The most common downstream surgery is needle biopsy (69.0%), followed by cytology (23.6%), bronchoscopy (18.6%) and surgery (23.8%). A total of 93 patients (20.1%) were diagnosed with lung cancer after screening.

Overall, the cost of lung screening for this population is US$5,060,511.04 (average US$740.06 per patient). In comparison, the total out-of-pocket expenses for this group are US$427,069.74 (US$62.46 per person).

“The [out-of-pocket] cost associated with subsequent testing represents an under-discussed risk, and SDM should include the patient’s financial consequences,” explained Tina D. Tailor, MD, of the Department of Radiology, Duke University Medical Center, and colleagues. Under study. “In view of the existing differences in lung cancer incidence and outcomes that impose a disproportionate burden on vulnerable groups, failure to fully address the costs associated with [lung cancer screening] may inhibit or prevent screening and/or necessary Follow-up testing. This may unintentionally widen the existing lung cancer differences."

In 2010, the Patient Protection and Affordable Care Act (PPACA) was enacted. This requires non-grandfather private and commercial insurance companies to underwrite USPSTF A and B recommendations without sharing costs. In addition, Medicare and most state Medicaid plans cover an annual LDCT lung cancer screening. Therefore, since 2013, the screening utilization rate has been steadily increasing.

In this study, the researchers retrospectively analyzed data collected from patients aged 55 to 79 who were screened from 2015 to 2017, and pointed out the types and frequency of downstream invasive procedures. The researchers then used linear and logistic regression to determine the total cost of each episode (defined as lung cancer screening and downstream procedures) and out-of-pocket costs. The results did not reveal any associations between downstream procedures and race/ethnicity, poverty level, geographic division, or type of health plan.

Out-of-pocket expenses increase with each downstream program. The cost of these procedures ranges from $0 to $342.05, with an average cost of $50.79. Of the 466 patients who underwent at least one follow-up procedure, 61% experienced out-of-pocket expenses.

Patients who were diagnosed with lung cancer in the subsequent surgery paid an average of US$332.24, and the out-of-pocket expenses for patients in this population ranged from US$0 to US$1,341.52. Those who did not undergo downstream procedures after screening did not experience out-of-pocket expenses.

It is worth noting that compared with patients in the central, eastern and northern regions, patients living in the Pacific region are more likely to pay out of pocket (OR, 1.67; 95% CI, 1.26-2.22). Patients living in the central and southwestern regions are the least likely to have out-of-pocket expenses of 0 (OR0.76; 95% CI, 0.61-0.95).

The type of health plan also affects patient costs. Zero cost is related to POS and PPO (OR, 0.67; 95% CI, 0.57-0.80) plans, not HMO plans (OR, 0.49; 95% CI, 0.29-0.83).

"Even a small (out-of-pocket) cost will burden the economically vulnerable, such as those living below the federal poverty line, who need to pay between their share of the cost and other family or medical expenses. Weigh," the study authors concluded. "Innovative insurance design requires adjustment of insurance premiums or [out-of-pocket] packages that cover the entire [lung cancer screening] event to reduce the financial burden of people eligible for [lung cancer screening]."

The study authors acknowledge that patients are required to have at least 12 months of continuous insurance coverage in a plan is limited. Therefore, patients who switched insurance or were not insured during the study period are not included, so program rates and expenses may be underrepresented. In addition, most of the included patients have POS health plans, so the results of the study may not be generalized to other health plan types. Finally, the cost does not take into account complications related to surgery. Further research should seek to address these factors to better assess the costs and expenditures associated with screening.

Tailor TD, Bell S, Fendrick AM, Carlos RC. The total cost and out-of-pocket cost of surgery after lung cancer screening for the national commercial insurance population: Estimated one-time care. J. American College of Radiology (pre-review). Available from: https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb-assets/Health%20Advance/journals/jacr/PreProofJACR_Manuscript_JACRAD-D-21-00091-1632519372147.pdf