Treating pure ground glass nodules is not a cost-effective strategy for imaging practices, according to a new large-scale analysis published Tuesday in Radiology.
Members of the specialty are increasingly identifying such lesions on chest CT, including in about 9% of patients undergoing lung cancer screening. Subsolid nodules have a high risk of becoming malignant, but they also grow slowly and have low potential of metastasizing, noted lead author Mark Hammer, MD.
“This may almost seem like a contradiction, but it presents a problem: How should we choose when to treat these (potential) cancers,” Hammer, a thoracic radiologist at Brigham and Women’s Hospital and assistant professor at Harvard, told Radiology Business by email. “If we address all of the cancers, we will probably end up overtreating a lot of patients who would have died with rather than of these cancers. So, we wanted to see if we can understand when to treat these lesions.”
To find the right balance, Hammer and colleagues used a simulation model, incorporating 10 million current and former smokers (assumed to have ground glass nodules) who underwent CT screening. The nodules were allowed to grow and develop solid components over time, and the model explored management strategies using various treatment thresholds. They further used formulas to determine how much extra the healthcare system might pay to give a patient an extra (quality-adjusted) life-year. In most studies, Hammer noted, people regard $100,000 as the upper limit, which is what the provider is paying, not the patient.
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June 16, 2021 at 06:49AM
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Treating pure ground glass nodules is not a cost-effective strategy, large-scale analysis finds - Radiology Business
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