title: Cost-benefit of minimally invasive staging of non-small cell lung cancer: a decision tree sensitivity analysis.
abstract: BACKGROUND
  Accurate staging of non-small cell lung cancer (NSCLC) is critical for optimal management. Minimally invasive pathologic assessment of mediastinal lymphadenopathy is increasingly being performed. The cost-benefit (minimization of health care costs) of such approaches, in comparison with traditional surgical methods, is yet to be established.
  
  
  METHODS
  Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), conventional TBNA, and surgical mediastinoscopy. Calculations were based on real costs derived from actual patient data at a major teaching hospital in Melbourne, Australia. One- and two-way sensitivity analyses were undertaken to account for potential variation in input parameter values.
  
  
  RESULTS
  For the base-case analysis, initial evaluation with EBUS-TBNA (with negative results being surgically confirmed) was the most cost-beneficial approach (AU$2961) in comparison with EBUS-TBNA (negative results not surgically confirmed) ($3344), conventional TBNA ($3754), and mediastinoscopy ($8859). The sensitivity of EBUS-TBNA for detecting disease had the largest impact on cost, whereas the prevalence of mediastinal lymph node metastases determined whether surgical confirmation of negative EBUS-TBNA results remained cost-beneficial.
  
  
  CONCLUSIONS
  Our study confirms that minimally invasive staging of NSCLC is cost-beneficial in comparison with traditional surgical techniques. EBUS-TBNA was the most cost-beneficial approach for mediastinal staging of patients with NSCLC across all studied parameters.
authors.affiliation: Department of Respiratory Medicine, Centre for Medical Research, Royal Melbourne Hospital, Parkville, Australia. daniel.steinfort@mh.org.au
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Steinfort
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Matthew
authors.initials: M
authors.lastname: Conron
authors.forename: Anastasia F
authors.initials: AF
authors.lastname: Hutchinson
authors.forename: Louis B
authors.initials: LB
authors.lastname: Irving
mesh_terms: D001315:Australia; D044963:Biopsy, Fine-Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019160:Endosonography; D019788:Fluorodeoxyglucose F18; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology*; D008481:Mediastinoscopy; D009367:Neoplasm Staging / Q000191:economics*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18