Author of

• 18749

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  P3.07 - Poster Session with Presenters Present (ID 493)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Regional Aspects/Health Policy/Public Health
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18751

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    P3.07-002 - Complications and Costs of Diagnostic and Post-Progression Biopsies among Patients with Non-Small Cell Lung Cancer (NSCLC) (ID 4762)

    14:30 - 14:30  |  Author(s): A.W. Fernandes
    • Abstract

    Background:
    With an increase in biomarker-directed therapies, tissue biopsy to identify targetable mutation status will become a mainstay of managing patients with NSCLC. The current study assessed the frequency, complications and costs of initial diagnostic biopsy (IDP) and post-progression biopsy (PPB) given the current limited information.
    
    Methods:
    This retrospective, observational study was conducted using administrative claims data from over 30 million commercially insured individuals in the US (2006-2014). Patients with continuous health-plan enrollment ≥12-months prior and ≥3-months post-index (first-observed) NSCLC diagnosis date were included and followed until health-plan disenrollment, study endpoint (December 2014) or death (whichever occurred earlier). Patients with NSCLC (n=20,013) were categorized into 4 groups (IDB only (58%); IDB+PPB (9%); PPB only (1%); and no biopsy (32%)) based on presence or absence of claim(s) for IDB and/or PPB. Biopsy procedures, post-biopsy complications and costs were assessed during the follow-up period. Identification of claims was based on ICD-9-CM diagnosis/procedure and/or HCPCS codes. All analyses were descriptive in nature.
    
    Results:
    Study included 20,013 patients (median age: 69 years) with 52% being females, 73% enrolled in a preferred provider organization and 35% managed in Midwest. 10% of the patients had a PPB. Bronchoscopy (IDB 53%; PPB 71%) and percutaneous needle biopsy (IDB 42%; PPB 21%) were the commonly employed biopsy procedures. 63% patients had a medical claim for at least 1-complication within 30-days post IDB for difficulty breathing (41%), severe chest pain (23%) or pneumothorax (14%). 30-day complication rate (61%) was similar among patients with a PPB. Among patients undergoing bronchoscopy higher proportion had medical claim for complications including difficulty breathing (IDB: 44% vs. 37%; PPB: 46% vs. 26%) and hemoptysis (IDB: 14% vs. 4%; PPB: 15% vs. 3%) compared with patients undergoing percutaneous needle biopsy. Average IDB episode costs were significantly higher among patients with a complication compared with patients without a complication (day of biopsy: $12,030 vs. $6,508; within 7-days: $13,657 vs. $7,765; p-value<0.001).
    
    Conclusion:
    In this large cohort of NSCLC patients the rate of PPB was 10%. Importantly, for the first time we determined that the rates of complications were similar for the IDB and PPB among patients enrolled in a large national US health plan. With likely increased demands by patients, providers and payers for diagnostics confirmation for biomarker-directed therapies, data from this study will be of value in comparing complications rate and determining budget-impact of newer less-invasive molecular testing methods.