JAMA study raises questions on lung cancer screening cost-effectiveness
- A new JAMA Internal Medicine study published this week calls into question if patients are adequately informed of the risks associated with invasive diagnostic procedures for lung abnormalities.
- Using a sample of 344,510 patients who had invasive diagnostic procedures between 2008 and 2013 aged 55 to 77 years, the researchers found complication rates about twice as high as the National Lung Screening Trial (NLST) that led to the addition of lung cancer screening as a Medicare preventative service in 2015.
- The researchers estimate the complication rate for the cohort study was 22.2% for those aged 55 to 64, while those from 65 to 77 experienced adverse outcomes 23.8% of the time. In comparison, the NLST found complication rates to be between 8.5% and 9.8%.
Costs associated with adverse events ranged from $6,320 to $56,845 depending on the age of the patient and type of complication, leading researchers to stress the importance for doctors to discuss the "risks of subsequent adverse events and downstream costs" with patients.
The researchers pointed to concern experts raised over the complications associated with invasive diagnostic procedures could be higher outside of the trial at the Medicare Evidence Development & Coverage Advisory Committee meeting held April 30, 2014, to discuss coverage.
"The financial burden of postprocedural complications can be great, as our data indicate that considerable costs are associated with the invasive diagnostic procedures and postprocedural complications," the authors wrote.
The new study shows that complication rates from community-based clinical practices should be used instead of clinical trials to better inform the cost-effectiveness of lung screening, the authors argued. They added that future research should examine the "positive association between age and complication rates."
"As the number of individuals seeking lung cancer screening with LDCT increases, so too will the number of individuals undergoing invasive diagnostic procedures as a result of abnormal findings," the researchers wrote.
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