Frequency, Complications, and Costs of Diagnostic and Postprogression Biopsies in NSCLC
In a retrospective study reported in the Journal of Oncology Practice, Kelly et al identified the frequency of diagnostic and postprogression biopsies, complication rates, and associated costs in patients with non–small cell lung cancer (NSCLC). The study involved patient data from the HealthCore Integrated Research Database (covering 30 million commercially insured individuals in the United States) from 2006 to 2014.
As stated by the investigators, “With an increase in biomarker-directed therapies, tissue biopsy to identify targetable genomic and immunologic alterations has become the mainstay of managing patients with NSCLC; however, little is known about the associated economic impact and complication rate.”
Biopsies, Complications, and Costs
Among 20,013 eligible patients included in the analysis, 13,411 (67%) had a diagnostic biopsy (mean cost = $9,977) and 2,056 (10%) had a postprogression biopsy (mean cost = $16,806). Complication rates were similar at diagnosis and after progression on the day of biopsy (10% vs 7%) and within 30 days after biopsy (63% vs 61%). Pneumothorax (n = 1,247, 9.09%) was the most common complication on the day of the biopsy. Trouble breathing (n = 6,409, 46.72%) and severe chest pain (n = 3,703, 26.99%) were the most common complications within 30 days of biopsy. In total, 8,973 patients (65.41%) were hospitalized within 30 days after biopsy.
Mean costs were higher (P < .001 for all comparisons) for patients with a complication vs those without a complication:
- On the day of biopsy: diagnostic biopsy = $12,030 vs $6,508; postprogression biopsy = $22,593 vs $7,812
- Within 7 days of biopsy: diagnostic biopsy = $13,657 vs $7,765; postprogression biopsy = $23,969 vs $8,932
- Within 30 days of biopsy: diagnostic biopsy = $24,968 vs $15,988; postprogression biopsy = $30,293 vs $12,494.
The investigators concluded, “From 2006 to 2014, postprogression biopsies were not common practice in NSCLC. Complication rates were similar at diagnosis and after progression, with mean costs higher among patients with a complication than those without a complication. With increasing demands for effective novel targeted therapies and safe testing methods, these data may be valuable in determining the budget impact and comparing complication rates with newer, less invasive molecular testing methods, including plasma circulating tumor DNA testing.”
Ronan J. Kelly, MD, MBA, of the Charles A. Sammons Cancer Center at Baylor University Medical Center, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: The study was supported by AstraZeneca. For full disclosures of the study authors, visit jop.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
