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. 2021 Oct;37(10):1731-1737.
doi: 10.1080/03007995.2021.1953972. Epub 2021 Jul 26.

Comparing the downstream costs and healthcare utilization associated with the use of low-dose computed tomography (LDCT) in lung cancer screening in patients with and without alzheimer's disease and related dementias (ADRD)

Yahan Zhang  1 , Jiang Bian  2   3 , Jinhai Huo  4 , Shuang Yang  2 , Yi Guo  2   3 , Hui Shao  1   3
Affiliations

Comparing the downstream costs and healthcare utilization associated with the use of low-dose computed tomography (LDCT) in lung cancer screening in patients with and without alzheimer's disease and related dementias (ADRD)

Yahan Zhang et al. Curr Med Res Opin. 2021 Oct.

Abstract

Objective: This study aims to compare the downstream costs and healthcare utilization associated with using low-dose computed tomography (LDCT) for lung cancer screening in patients with and without Alzheimer's disease and related dementias (ADRD).

Methods: Based on data from IBM MarketScan Commercial Claims Databases (2014-2018), we have identified four study cohorts: ADRD and non-ADRD patients who went through LDCT screening; ADRD and non-ADRD patients without LDCT screening. Annually healthcare utilization and cost were grouped into outpatient, inpatient, and pharmacy. We used difference-in-differences (DID) models to estimate the downstream healthcare utilization and cost associated with LDCT screening in both ADRD and non-ADRD population. We used a difference-in-difference-in-differences (DDD) model to explore whether LDCT screening was associated with higher downstream cost and healthcare utilization in ADRD population than non-ADRD population.

Result: Compared to individuals without LDCT screening, LDCT screening was associated with increased outpatient visits (2.1, 95% CI 0.7, 3.4) and outpatient cost ($2301.0, 95% CI 296.2, 4305.8) in the ADRD population and increased outpatient visits (0.6, 95% CI 0.1, 1.1) in the non-ADRD population within 1 year after screening. Compared with the non-ADRD population, LDCT screening was found to be associated with an additional 1.5 (95% CI 0.2, 2.8) outpatient visits, 0.7 (95% CI 0.1, 1.3) days of inpatient stays, and $4,960.4 (95% CI 532.7, 9388.0) in overall healthcare costs within 1-year after LDCT in the ADRD population (all p < .5).

Conclusion: The downstream cost and healthcare utilization associated with LDCT screening were found to be higher in the ADRD population compared to the average population.

Keywords: Alzheimer’s disease and related dementias; Lung cancer screening; expenditures; healthcare utilization; low-dose computed tomography.

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Figures

Figure 1.
Figure 1.
Healthcare expenditure and utilization 1-year before and after the LDCT screening. 1-year outcomes before and after the index date of the four groups. Respectively, (a) Sum of outpatient, inpatient and pharmacy expenditure. (b) Outpatient expenditure. (c) Times of outpatient visits. (d) Inpatient expenditure. (e) Total days of inpatient stays. (f) Pharmacy expenditure. (g) Total days’ supply of prescribed medicines. aAlzheimer’s disease and related dementias. b Low-dose computed tomography.
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