Thoracic Oncology Multidisciplinary Clinic Reduces Unnecessary Health Care Expenditure Used in the Workup of Patients With Non-small-cell Lung Cancer

Khinh Ranh Voong; Ou Stella Liang; Patrick Dugan; Deirdre Torto; William V Padula; James P Senter; Margaret Lang; Craig M Hooker; Josephine Feliciano; Stephen Broderick; Lonny Yarmus; Kanika Khanna; Amol Narang; Russell K Hales

doi:10.1016/j.cllc.2019.02.010

Thoracic Oncology Multidisciplinary Clinic Reduces Unnecessary Health Care Expenditure Used in the Workup of Patients With Non-small-cell Lung Cancer

Clin Lung Cancer. 2019 Jul;20(4):e430-e441. doi: 10.1016/j.cllc.2019.02.010. Epub 2019 Mar 12.

Authors

Affiliations

¹ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD. Electronic address: kvoong1@jhmi.edu.
² Department of Financial Analysis, Johns Hopkins Medical Institutions, Baltimore, MD.
³ Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD.
⁴ Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁵ The Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD.
⁷ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD.
⁸ Department of Oncology, Johns Hopkins University, Baltimore, MD.
⁹ Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD.

PMID: 30956040
DOI: 10.1016/j.cllc.2019.02.010

Abstract

Background: National costs of lung cancer care exceed $12 billion. We investigate the resource-savings benefit of a single-day thoracic oncology multidisciplinary clinic (MDC) in the diagnostic period prior to non-small-cell lung cancer (NSCLC) treatment.

Materials and methods: From July 2007 to January 2015, patients with NSCLC treated with multimodality therapy at a tertiary hospital-based cancer center in Maryland were identified. Patient and treatment details were collected. Health care resources utilized in the 90 days prior to receipt of first oncologic treatment were identified using billed activity codes. Associated total charges, including professional fees and hospital-based technical fees, were identified and inflated to 2014 dollars using the Consumer Price Index. Codes were categorized into provider visits, procedures, pathology/laboratory, radiology, and other tests. χ², Student t, and Wilcoxon rank-sum tests compared charges of patients seen in and out of the MDC.

Results: Two-hundred ninety-seven (non-MDC = 161, 54%; MDC = 136, 46%) of 308 patients identified had total charges available. Patients seen through MDC had on average a 23% decrease in total charges per patient incurred ($5839 savings; range, $5213-$6464) compared with patients seen through non-MDC settings. Evaluation through MDC reduced the average number of provider visits per patient (non-MDC, 6.8 vs. MDC, 4.8; P < .01) prior to treatment start, which led to a 50% (average $3092; range, $2451-$3732) reduction in provider charges per patient (P < .01).

Conclusions: Evaluation of patients with NSCLC through a coordinated single-day MDC reduced hospital charges per patient by 23% during the diagnostic period prior to treatment when compared with evaluation through traditional referral-based thoracic oncology clinics.

Keywords: Diagnostic work-up; Economic evaluation; Hospital charges; Non-small cell lung cancer; Single-day multidisciplinary cancer clinic.

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung / diagnosis
Carcinoma, Non-Small-Cell Lung / economics*
Cost-Benefit Analysis
Early Detection of Cancer
Female
Health Expenditures / standards*
Hospital Charges
Humans
Interdisciplinary Communication
Lung Neoplasms / diagnosis
Lung Neoplasms / economics*
Male
Middle Aged
Neoplasm Staging
Retrospective Studies
United States