Cost effectiveness of endosonography versus surgical staging in potentially resectable lung cancer: a health economics analysis of the ASTER trial from a European perspective.
In the ASTER study, mediastinal staging was more accurate for patients randomised to combined endobronchial and endoscopic ultrasound, followed by surgical staging if endoscopy was negative, versus surgical staging alone. Here, we report survival, quality of life and cost effectiveness up to 6 months, for the UK, The Netherlands and Belgium, separately. Survival in the two arms of the study was similar. In all three countries, the endosonography strategy had slightly higher quality-adjusted life years over 6 months, and was cheaper. Therefore, based on clinical accuracy and cost effectiveness, we conclude that mediastinal staging should commence with endosonography.
Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
Robert C
RC
Rintoul
Health Economics Research Group, Brunel University, Middlesex, UK.
Matthew J
MJ
Glover
MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK.
Christopher
C
Jackson
Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
Victoria
V
Hughes
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium Department of Respiratory Medicine, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
Kurt G
KG
Tournoy
Department of Respiratory Medicine, University of Leuven, Leuven, Belgium.
Christophe
C
Dooms
Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Jouke T
JT
Annema
Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK Clinical Trials Research Unit, University of Leeds, Leeds, UK.
Linda D
LD
Sharples
D001499:Bayes Theorem; D001530:Belgium / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D019160:Endosonography / Q000191:economics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011013:Pneumonectomy / Q000191:economics*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology
Bronchoscopy; Health Economist; Lung Cancer; Non-Small Cell Lung Cancer; Thoracic Surgery