Cost-Efficacy of Endoscopic Ultrasonography with Fine-Needle
Aspiration vs. Mediastinotomy in Patients with Lung Cancer
and Suspected Mediastinal Adenopathy
L. Aabakken, G. A. Silvestri, R. Hawes, C. E. Reed, V. Marsi, B. Hoffman
Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Pulmonary Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Thoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Background and Study Aims: 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.
Patients and 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.
Conclusion: Because of its low cost and high yield, EUS-guided FNA is a cost-effective aid assessing mediastinal lymphadenopathy.
References
1
Dales R E, Stark R M, Sankaranarayanan R.
Computed tomography to stage lung cancer.
Am Rev Respir Dis.
1990;
141
1096-1101
2
Coughlin M, Deslauriers J, Beaulieu M, et al.
Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer.
Ann Thor Surg.
1985;
40
556-560
3
Eddy R J.
Cost-effectiveness of CT scanning compared with mediastinoscopy in the preoperative staging of lung cancer.
Can Assoc Radiol J.
1989;
40
189-193
6
Silvestri G A, Hoffman B J, Bhutani M S, et al.
Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.
Ann Thorac Surg.
1996;
61
1441-1446
7
Gress F G, Savides T J, Sandler A, et al.
Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: a comparison study.
Ann Intern Med.
1997;
127
604-612
8
Ginsberg R J, Rice T W, Goldberg M, et al.
Extended cervical mediastinoscopy. A single staging procedure for bronchogenic carcinoma of the left upper lobe.
J Thorac Cardiovasc Surg.
1987;
94
673-678
10
Grilli R, Oxman A D, Julian J A.
Chemotherapy for advanced non-small-cell lung cancer: how much benefit is enough?.
J Clin Oncol.
1993;
11
1866-1872
11
Luke W P, Pearson F G, Todd T R, et al.
Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung.
J Thorac Cardiovasc Surg.
1986;
91
53-56