Ann Thorac Surg. 2020 Oct 5:S0003-4975(20)31617-9. doi: 10.1016/j.athoracsur.2020.07.048. Online ahead of print.
BACKGROUND: The longitudinal cost of treating patients with non-small cell lung cancer (NSCLC) undergoing surgical resection has not been evaluated. We describe initial and 4-year resource use and cost for NSCLC patients ≥65 years of age treated surgically between 2008 and 2013.
METHODS: Using clinical data for NSCLC resections from the Society of Thoracic Surgeons General Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery and subsequent care through 4 years were examined ($2017). Cost of hospital-based care was estimated using cost-to-charge ratios; professional services and care in other settings were valued using reimbursements. Inverse probability weighting was used to account for administrative censoring. Outcomes were stratified by pathologic stage, and by surgical approach for Stage I lobectomy patients.
RESULTS: Resection hospitalizations averaged 6 days and cost $31,900. In the first 90 days, costs increased with stage ($12,430 Stage I to $26,350 Stage IV). Costs then declined towards quarterly means more similar among stages. Cumulative costs ranged from $131,032 (Stage I) to $205,368 (Stage IV). In the Stage I lobectomy cohort, patients selected for minimally invasive procedures had lower 4-year costs than thoracotomy patients ($120,346 versus $136,250).
CONCLUSIONS: The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among Stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of post-operative intensive care and earlier detection and treatment of disease.