title: Radial probe EBUS versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis.
abstract: Selection of the optimal procedure for minimally invasive diagnosis of peripheral pulmonary lesions (PPLs) may be based on clinical factors; however, selection of diagnostic strategy may also be influenced by cost. Economic analysis of minimally invasive diagnosis of PPL has not been performed previously. Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) with computed tomography-guided percutaneous needle biopsy (CT-PNB). Calculations were based on real costs derived from patient data. Sensitivity analyses and probabilistic sensitivity analysis were undertaken to identify the more cost-beneficial approach for varying input parameter values. Cost-effectiveness calculations were based on estimated disutility, according to the wait-trade-off technique. For base-case analysis, initial evaluation with CT-PNB was cost-beneficial (AU$2,724 versus EBUS-TBLB AU$2,748). The variable which exerted the most influence on cost-benefit outcomes was the cost of managing complications. CT-PNB remained the more cost-effective procedure at base-case parameters, although thresholds were identified during sensitivity analysis where EBUS-TBLB became more cost-effective. The costs of EBUS-TBLB and CT-PNB to evaluate PPL appear to be equivalent, but specific clinical-radiologic factors known to influence procedural outcomes will influence cost-benefit outcomes. Further evaluation of patient preferences and their influence on cost-effectiveness are required.
authors: Royal Melbourne Hospital, Parkville, Australia. daniel.steinfort@mh.org.au
authors: Daniel P
authors: DP
authors: Steinfort
authors: Danny
authors: D
authors: Liew
authors: Louis B
authors: LB
authors: Irving
mesh_terms: D001707:Biopsy, Needle / Q000191:economics / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019160:Endosonography / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis* / Q000191:economics*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology; D008962:Models, Theoretical; D009010:Monte Carlo Method; D011336:Probability; D012680:Sensitivity and Specificity; D016896:Treatment Outcome