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Abstract
Introduction The diagnosis of lung cancer at emergency presentation with hospital admission is a poor patient experience and is likely to incur significant cost. Reducing the proportion of patients diagnosed by this route has been identified as a priority by policy makers. The full health-economic impact of this route to diagnosis is not known.
Aim To measure the excess healthcare costs attributable to emergency hospital admission in patients diagnosed with lung cancer.
Methods Retrospective review of an electronic database of lung cancer patients from 2008–2013. Secondary care costs were acquired from the local NHS Patient Level Information and Costing System (PLICS) with adjustment for inflation. To adjust for survival differences, secondary analyses looked at average costs incurred only while patients remained alive.
Results 3,274 consecutively diagnosed patients were included. Mean one and twelve-month costs were £2,400 (95% CI £2,313-£2,493) and £10,009 (95% CI £9,725-£10,285). One month mean costs for patients with emergency admission were higher than for those diagnosed by other routes (£3,499 (95% CI £3,332-£3,667) vs £1,899 (95% CI £1,810-£1,999)). Twelve month mean costs for emergency admissions were lower than for other routes (£8,123 (95% CI £7,704-£8,552) vs £10,870 (95% CI £10,511-£11,211)), but this analysis is heavily influenced by excess mortality within the emergency admission group (1 year survival 14% vs 50% respectively).
Mean costs for survival, only considering costs per patient alive in that month, are shown in Figure 1. Emergency admission was associated with increased mean alive costs compared to other routes at both one month (£3,499 vs £1,899) and 12 months (£15,063 vs £13,233). Adjusted costs accrued between one and twelve months following diagnosis were similar between the two groups (£11,565 vs £11,334).
Conclusion Patients diagnosed with lung cancer during an emergency admission incur greater healthcare costs during the first month following diagnosis. Lower longer term costs in these patients seem to be entirely due to the lower survival rates in this poor prognosis group.
In addition to improving patient experience and outcome, strategies to increase earlier diagnosis of lung cancer may reduce the additional healthcare costs associated with this route to diagnosis.