Analysis of Wait Times and Costs During the Pen-Diagnostic Period for Non-Small Cell Lung Cancer

Purpose: To determine the wait times and healthcare costs around the time of non-small cell lung cancer (NSCLC) diagnosis for a large, population-based cohort of patients. Methods: Data on baseline demographics, diagnostic and staging tests, timelines of investigations, and frequency of physician visits and hospital admissions were obtained from a provincial cancer registry and health administrative databases for 2852 patients, who were diagnosed with NSCLC from 1996 to 2000 in Manitoba, Canada. Dates between investigations were used to determine wait times surrounding diagnosis and fee codes for physician and hospital services were used to estimate costs. Results: The median wait times from chest x-ray to chest computed tomography (Cr) scan and from Cr scan to definitive histological diagnosis were 8 (inter-quartile range 1-25) and 18 (inter-quartile range 3-42) days, respectively. At least 25% of patients waited more than 55 days from initial suspicion on chest x-ray to final diagnosis of NSCLC. The mean cost per case of NSCLC diagnosis was $6,978 (in Canadian dollars) where the majority of expenses was attributed to hospital admissions and repeated physician visits before a diagnosis was confirmed. Conclusions: Despite clinical suspicion for NSCLC, a significant number of patients wait more than 8 weeks for a definitive diagnosis. Substantial costs are incurred by the Canadian universal healthcare system in the months surrounding diagnosis. Establishment of more efficient and cost-effective healthcare delivery in the pen-diagnostic time period may benefit the system as well as the patients. (C) 2010 Elsevier Ireland Ltd. All rights reserved.