Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs. mediastinotomy in patients with lung cancer and suspected mediastinal adenopathy.
OBJECTIVE
The use of endoscopic ultrasonography (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has become an important aid in the staging of bronchogenic carcinoma. In many cases, it may be an alternative to mediastinoscopy/mediastinotomy (MED), but the cost-effectiveness of the two techniques has not been compared. The aim of this study was to apply a decision-analysis model to compare the cost-effectiveness of EUS and MED in the preoperative staging of patients with non-small-cell lung cancer.


METHODS
A decision-analysis model was designed, taking as entry criteria lung cancer and abnormal mediastinal lymph nodes verified by computerized tomography (CT). Performance characteristics of MED and EUS were retrieved from the published literature, as were life expectancy data. Direct actual costs of the relevant procedures were retrieved from the billing system of our hospital.


RESULTS
The cost per year of expected survival is US$ 1.729 with the EUS strategy, and US$ 2.411 with the MED strategy. The advantage conferred by EUS remains even when the negative predictive value of EUS is as low as 0.22.


CONCLUSIONS
Because of its low cost and high yield, EUS-guided FNA is a cost-effective aid assessing mediastinal lymphadenopathy.
Aabakken
L
L
Digestive Disease Center, Department of Pulmonary Medicine, Medical University of South Carolina, Charleston, USA. larsaa@ioks.uio.no
Silvestri
G A
GA
Hawes
R
R
Reed
C E
CE
Marsi
V
V
Hoffman
B
B
D001707:Biopsy, Needle / Q000191:economics*; D002283:Carcinoma, Bronchogenic / Q000191:economics* / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019160:Endosonography / Q000191:economics*; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy / Q000191:economics*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests