Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study.
OBJECTIVE
To evaluate the cost effectiveness of the Nd-YAG laser and bronchoscopic electrocautery for palliation in patients with symptomatic tumor obstruction.


METHODS
A retrospective study.


METHODS
Bronchoscopy unit of a university hospital.


METHODS
Thirty-one consecutive patients with inoperable non-small cell lung cancer and symptomatic intraluminal tumor underwent bronchoscopic treatment. Dyspnea relief was the primary goal of treatment. Fourteen patients were treated with the Nd-YAG laser and 17 patients with electrocautery.


RESULTS
Improvement of symptoms was achieved in 70% of patients treated by either Nd-YAG laser or electrocautery. Mean +/- SD survival was 8.0 +/- 2.5 months after Nd-YAG laser treatment and 11.5 +/- 3.5 months after electrocautery. The number of treatment sessions per patient was comparable: Nd-YAG laser, 1.1; electrocautery, 1.2. Duration of hospital stay was longer in patients treated with the Nd-YAG laser (8.4 vs 6.7 days). Average treatment costs, including admission charges, were $5,321 for the Nd-YAG laser and $4,290 for electrocautery. Higher costs in the group treated with the Nd-YAG laser were caused by a longer hospital stay before bronchoscopic treatment. Costs of equipment (electrocautery $6,701 and Nd-YAG laser $208,333), write-offs, maintenance, and repair were not included in this calculation.


CONCLUSIONS
Bronchoscopic electrocautery is equally effective but is a less expensive and, in our hospital, a more accessible modality than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.
Boxem
T v
Tv
Department of Pulmonary Medicine, University Hospital Vrije Universiteit Amsterdam, The Netherlands.
Muller
M
M
Venmans
B
B
Postmus
P
P
Sutedja
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000191:economics / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000191:economics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000191:economics / Q000601:surgery; D003362:Cost-Benefit Analysis; D004564:Electrocoagulation / Q000191:economics*; D004724:Endoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000191:economics; D008175:Lung Neoplasms / Q000150:complications / Q000191:economics / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome