Total and Out-of-Pocket Costs of Procedures After Lung Cancer Screening in a National Commercially Insured Population: Estimating an Episode of Care.

OBJECTIVE Consequences of lung cancer screening (LCS) with low-dose chest CT in clinical settings, including procedures, costs, and complications, are incompletely understood. We evaluated downstream invasive procedures after LCS, total and out-of-pocket (OOP) costs of these procedures, and correlates of procedural rates and costs. METHODS Using the Clinformatics Data Mart, we retrospectively included patients between ages 55 and 79 years receiving LCS between 2015 and 2017. The types and frequency of downstream invasive procedures (including needle biopsy, bronchoscopy, surgery, and cytology) were described. Treating the LCS examination and downstream procedures as a single LCS episode, we described the per-episode total costs (insurance reimbursement + OOP costs of LCS and downstream procedures) and OOP costs. Correlates of costs were determined using linear and logistic regression. RESULTS A total of 6,268 patients received at least one low-dose chest CT; 462 patients (7.4%) received at least one procedure within 12 months after LCS (needle biopsy 69.0%, cytology 23.6%, bronchoscopy 18.6%, surgery 23.8%). Women and patients ≥65 years were more likely to receive a downstream procedure. Ninety-three patients (20.1%) were diagnosed with lung cancer after LCS. The total cost of managing this population of lung screeners was $5,060,511.04, with an average per-episode total cost of $740.06. The aggregate OOP costs to this population of lung screeners was $427,069.74, with an average per-episode OOP cost of $62.46. CONCLUSIONS Rates of invasive procedures after LCS in a commercially insured population exceeded those of clinical trials. Considering LCS and associated downstream procedures as an episode of care results in modest OOP cost.