title: Cost-effectiveness analysis of transbronchial needle aspiration of pulmonary lesions without endobronchial affectation.
abstract: Transbronchial needle aspiration (TBNA) of pulmonary lesions without endobronchial affectation in combination with transbronchial biopsy (TBB) has been shown to increase diagnostic performance. The objective of this present study was to analyze whether the combination of TBNA with conventional TBB is a cost-effective approach.
  
  
  METHODS
  Ours is a prospective study that included patients with lung nodules or masses with no evidence of endobronchial lesions after flexible bronchoscopy in whom both TBNA and TBB were performed. We analyzed the additional diagnostic value, the impact of TBNA on the cost of the diagnosis and the minimum level of sensitivity required in order for TBNA combined with TBB to be considered a cost-effective diagnostic approach.
  
  
  RESULTS
  Thirty-six patients were included in the study, 25 of whom were males. TBB reached a histologic diagnosis in 39% of the cases, and its combination with TBNA diagnosed 47%. The mean diameter of the lesions was significantly greater in the positive TBNA cases compared with the negative cases (31 vs. 23mm; p=0,034). The cost analysis did not show the additional TBNA to be more cost-effective, despite demonstrating greater diagnostic sensitivity. The minimum sensitivity required for TBNA combined with TBB to be considered a cost-effective approach was 88%.
  
  
  CONCLUSIONS
  The contribution of TBNA to TBB in the diagnosis of lung nodules or masses without associated endobronchial lesions does not seem to justify the additional economic cost.
authors.affiliation: Servicio de Neumología, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España. virginia.leiro.fernandez@sergas.es
authors.forename: Virginia
authors.initials: V
authors.lastname: Leiro Fernández
authors.forename: Maribel
authors.initials: M
authors.lastname: Botana Rial
authors.forename: Cristina
authors.initials: C
authors.lastname: Represas Represas
authors.forename: Ana
authors.initials: A
authors.lastname: González Piñeiro
authors.forename: Victor
authors.initials: V
authors.lastname: Del Campo Pérez
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández-Villar
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000191:economics* / Q000379:methods*; D001980:Bronchi; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000473:pathology*; D008297:Male; D011446:Prospective Studies