Purpose: To evaluate the benefits of lung cancer screening, all effects of screening need to be considered. Thus, we sought to determine whether screening had an effect on health care utilization by those being screened.

Methods: We recruited 400 individuals who were participating in a CT efficacy study at the University of Pittsburgh. We collected self reported health care utilization (outpatient, inpatient, and emergency room) for the 6 months prior to screening, and 0-6 months and 6-12 months following screening. The screening outcomes (objective risk of cancer) were negative (<1%), indeterminate (1-5%), and suspicious (15-20%). Poisson and mixed model regression were used to examine differences among screening categories for each period of utilization, changes in utilization over time, and how changes in time varied among the screening outcome groups.

Results: Average total outpatient visits for the three 6 month time periods were 1.9, 2.9 and 1.8 overall participants. They were slightly, but not significantly higher for those with a suspicious screening result (2.1, 3.3, 2.4). On average, outpatient visits for lung related reasons were low, 0.07, 0.29, and 0.13 for the three surveys. , In each of the two periods following screening, lung related visits for individuals with an indeterminate (0.37 first post-screen survey, 0.19 second post-screen survey) or suspicious (1.29, 0.68) result had significantly more visits than those with a negative (0.13, 0.04) screen. In multivariable analysis, total visits followed a significant concave time trend, but there were no differences in this trend among the screening categories. Visits attributed to lung issues also followed a significant concave trend overall, but the increase following screening was significantly greater for those with an indeterminate or suspicious screening result.

When outpatient use is divided into visits to PCPs, specialists, psychologist/psychiatrists, and other, no difference among screening categories or trends over time were found. The same result was found for number of inpatient visits and days, and emergency room visits.

Conclusions: Lung cancer screening does not have a large impact overall on self-reported health care utilization, although it does increase visits attributed to lung issues, especially for those with indeterminate or suspicious screening. Thus, it does not appear that lung cancer screening is excessively costly in terms of raising health care utilization and costs following screening.