Increasing Use of Percutaneous Liver Biopsy Accompanied by Growing Costs

05/06/16

A study of image-guided percutaneous liver biopsy (PLB) in patients with hepatocellular carcinoma has found that the procedure is increasingly being used in recent years despite safety concerns as well as rising costs associated with the procedure. 

Hepatocellular carcinoma, a common form of liver cancer, is one of the most frequently diagnosed cancer types among men and women worldwide. Additionally, the liver is often a site of metastasis for lung, pancreatic, colorectal, breast, and stomach cancers. PLB, guided by imaging methods such as CT (computed tomography) or MRI (magnetic resonance imaging) scans, plays an important role in the diagnosis of liver cancer, but questions have arisen regarding its safety when used to stage disease or monitor treatment efficacy.

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With these concerns in mind, researchers led by Dawn L Hershman, MD, MS, Columbia University Medical Center (New York, NY), aimed to evaluate the safety, utilization, and cost of PLB over the last 10 years in a study published in Cancer Investigation

For their study, the researchers identified 26,941 patients with cancer who received an image-guided PLB between 2006 and 2012. All data was taken from the Perspective Database, which is a voluntary, fee-supported database that collects inpatient and outpatient information from more than 600 hospitals throughout the United States. The majority of patients were over the age of 60 years (70.1%) and were insured by Medicare (56.2%), with slightly more males (53.1%) than females being included in the study.

Most biopsies were guided by CT scans (67.2%), whereas others were guided by ultrasound (28.5%) or fluoroscopy (4.7%). Overall, the number of image-guided PLBs more than doubled over the 7-year study period, increasing from 2228 in 2006 to 5410 in 2012.This growth was most evident in the number of outpatient claims, which increased from 925 to 3372 in 2006 and 2012, respectively. 

The cost of the image-guided PLB also rose significantly over the study period, increasing more than 25% from $940 in 2006 to $1176 in 2012. The researchers also found that median cost changed depending upon the method used. CT-guided PLB had the lowest median cost at $1445, followed by ultrasound, which cost $1456. The median cost for all other imaging techniques was $2607. 

Hemorrhage after image-guided PLB was uncommon, occurring in only ~1.43% of patients (n = 387), though nearly half of those patients (44%) required blood transfusions. The risk of hemorrhage also seemed to be higher after inpatient biopsy (2.6%) than outpatient biopsy (0.6%). And, whereas ultrasound- and CT-guided PLBs had similar hemorrhage incidence rates (1.4% and 1.3%, respectively), the risk was almost 3 times higher when other imaging methods were used. However, no changes in hemorrhage risk were seen over time. 

The researchers concluded that, although the use of image-guided PLB has increased over time, the rate of post-procedure hemorrhage has remained constant. They also noted that the increased costs associated with the procedure were tied to the imaging technique used to guide the procedure; therefore, stricter guidance regarding imaging techniques may be required in order to better control costs.—Sean McGuire

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Cui Z, Wright JD, Accordino MK, et al. Safety, utilization, and cost of image-guided percutaneous liver biopsy among cancer patients. [Published online ahead of print April 11, 2016]. Cancer
Invest.
doi:10.3109/07357907.2016.1166232.