PCN217 Biopsy frequency and variability among lung cancer patients in the United States
Zhang Y, Simoff MJ, Wagner O, Lavin J, and Shi L. PCN217 BIOPSY FREQUENCY AND VARIABILITY AMONG LUNG CANCER PATIENTS IN THE UNITED STATES. Value in Health 2019; 22:S97.
Value in Health
Objectives: Little is known regarding frequency and complexity of diagnosing lung cancer in real-world practice. This study aimed to describe distribution of biopsy procedures for patients diagnosed and treated for primary lung cancer. Methods: The observational study used IBM (formerly Truven) MarketScan® Databases from 2013 to 2015. Subjects included were ≥18 years old, had one primary lung cancer diagnosis, continuous health plan enrollment six months prior to and after their diagnosis and received at least one lung tissue biopsy. ICD-9-CM and ICD-10-CM codes were used to identify lung cancer. Biopsy procedures were identified using CPT codes and were stratified into percutaneous, bronchoscopic and surgical categories. Treatments were identified using CPT codes and NDC codes and included chemotherapy, radiation, and ablation. Results: Among 136,760 subjects diagnosed with primary lung cancer, 19,510 subjects met specific inclusion criteria. From this population, 15,587 subjects were further identified as patients who received lung cancer specific treatment after the biopsy. Average age was 66.4 (SD=11.57) years and included 9,810 (50.3%) female patients. The total number of lung biopsies performed was 33,096; an average of 1.7 biopsies per subject. Biopsy by approach was 14,141 (42.7%) bronchoscopic, 15,615 (47.2%) percutaneous, and 3,340 (10.1%) surgical. While 10,474 (53.7%) subjects had only one biopsy, 9,036 (46.3%) subjects had two or more biopsies. The cumulative interval days from first to fourth biopsy averaged 57.2 (SD=49.70) days. Among the treated subgroup, 8,340 (53.5%) subjects had one biopsy, whereas 7,247 (46.5%) subjects had multiple biopsies prior to initial treatment. Conclusions: Nearly half of the subjects in this population experienced multiple biopsies prior to a diagnosis of lung cancer. Further, biopsy choice in patients receiving multiple procedures was unpredictable. Future research is needed to better understand the patient journey.