Potentially Avoidable Healthcare Costs Associated With Delayed Diagnosis of Fibrotic Interstitial Lung Disease (ILD)
Recommended Citation
Shetty S, Shah S, Pimple P, Kim HJ, Gibson B, Pettersson C, Hicks W, Lloyd C, Lamerato L, Vaughn IA, Olson AL, Berger A. Potentially Avoidable Healthcare Costs Associated With Delayed Diagnosis of Fibrotic Interstitial Lung Disease (ILD). Am J Respir Crit Care Med 2024; 209:A7295.
Document Type
Conference Proceeding
Publication Date
5-22-2024
Publication Title
Am J Respir Crit Care Med
Abstract
Rationale: Fibrotic interstitial lung disease (ILD) is challenging to diagnose, as its symptoms (dyspnea, cough and fatigue) mimic other common cardiopulmonary disorders. As appropriate clinical management hinges on an accurate diagnosis, delays may worsen clinical outcomes and increase healthcare costs. This study aimed to understand the potentially avoidable costs associated with delays in diagnosis. Methods: We used Henry Ford Health's data for patients aged ≥18 years enrolled in Health Alliance Plan (HAP) who met prespecified criteria for fibrotic ILD. ILD status and diagnosis date were confirmed through chart review. Patients needed to be continuously enrolled in HAP for 5 years prior to diagnosis. Demographic and clinical characteristics were obtained from electronic health data and chart review. Date of earliest ILD symptom was assigned based on chart review, and time to diagnosis was categorized as timely (≤6 months from earliest attributable symptom) or delayed (>6 months from earliest attributable symptom). Healthcare costs, defined as total reimbursed amounts associated with all healthcare services between symptom onset and diagnosis date were estimated on both an aggregate and monthly basis.Results: Among 240 patients who met all selection criteria, 57.5% (n=138) experienced delayed diagnosis. Mean (SD) time to diagnosis was 16.8 (18.1) months (2.2 [1.5] for timely diagnosis; 27.5 [17.3] for delayed diagnosis). Those with delayed diagnosis were slightly older (mean [SD] age: 74.0 [10.4] vs 72.9 [11.5] in timely cohort), more likely to be female (55.8% vs. 40.2%), African American (27.5% vs. 21.6%), and to have family history of ILD (23.9% vs.17.6%). Mean (SD) total healthcare costs between date of earliest symptom and diagnosis were $25,206 ($47,101) among patients with timely diagnosis vs. $66,470 ($79,709) for those with delayed diagnosis. Among the latter, $46,419 (72% of total costs) were incurred > 6 months following initial symptom. Relative to timely diagnosis, patients with delayed diagnosis had nearly twofold higher costs of inpatient care, ED visits, and pulmonologist visits; nearly threefold higher for diagnostic testing; and 4-5 times higher for cardiologists and general practitioner visits (Table 1). A 6-month diagnostic delay could result in $16,548 of potentially avoidable healthcare costs; an 18-month delay, $49,644; and a 24-month delay, $66,192.Conclusion: Delayed diagnosis of fibrotic ILD is associated with substantial healthcare costs, some of which may be avoidable with timely diagnosis. Further research is needed to understand the relationship between diagnostic delay and clinical outcomes in this patient population and use and cost of healthcare services.
Volume
209
First Page
A7295
