Cost-Effectiveness of Initial Diagnostic Strategies for Pulmonary Nodules Presenting to Thoracic Surgeons
Cost-Effectiveness of Initial Diagnostic Strategies for Pulmonary Nodules Presenting to Thoracic Surgeons
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DOI：
10.1016/j.athoracsur.2014.05.025
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发表时间：
2014-10-01
影响因子：
4.6
通讯作者：
Grogan, Eric L.
中科院分区：
文献类型：
--
作者：
Deppen, Stephen A.;Davis, William T.;Grogan, Eric L.
背景因肺部结节提示肺癌而就诊于胸外科医生的患者有多种诊断选择，包括导航支气管镜检查（NB）、计算机断层扫描引导细针抽吸（CT-FNA）、F-18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和视频辅助胸腔镜手术（VATS）。我们研究了一个1.5至2厘米的结节提示癌症的相对成本效益的初步诊断策略。一个决策分析模型的开发，以评估成本和结果的四个初步诊断策略诊断一个1.5至2厘米的结节，无论是50%或65%的癌症的预测概率。医疗保险报销率用于成本。根据病理分期和文献中的效用，使用患者生存率估计质量调整生命年。当癌症患病率为65%时，NB和CT-FNA的组织获取策略与FDG-PET或VATS相比具有更高的质量调整生命年，并且VATS是最昂贵的策略。在敏感性分析中，当FDG-PET特异性低于72%时，NB和CT-FNA比FDG-PET更具成本效益。当癌症患病率为50%时，NB、CT-FNA和FDG-PET具有相似的成本-效果。NB和CT-FNA诊断策略比VATS活检或FDG-PET扫描更具成本效益，可诊断中高危结节中的肺癌，并且当FDG-PET特异性低于72%时，可减少非治疗性手术。在该国特异性低的地区，用于诊断肺癌的FDG-PET扫描可能不具有成本效益。(C)2014年由胸外科医师协会
Background. Patients presenting to thoracic surgeons with pulmonary nodules suggestive of lung cancer have varied diagnostic options including navigation bronchoscopy (NB), computed tomography-guided fine-needle aspiration (CT-FNA), F-18-fluoro-deoxyglucose positron emission tomography (FDG-PET) and video-assisted thoracoscopic surgery (VATS). We studied the relative cost-effective initial diagnostic strategy for a 1.5- to 2-cm nodule suggestive of cancer.Methods. A decision analysis model was developed to assess the costs and outcomes of four initial diagnostic strategies for diagnosis of a 1.5- to 2-cm nodule with either a 50% or 65% pretest probability of cancer. Medicare reimbursement rates were used for costs. Quality-adjusted life years were estimated using patient survival based on pathologic staging and utilities derived from the literature.Results. When cancer prevalence was 65%, tissue acquisition strategies of NB and CT-FNA had higher quality-adjusted life years compared with either FDG-PET or VATS, and VATS was the most costly strategy. In sensitivity analyses, NB and CT-FNA were more cost-effective than FDG-PET when FDG-PET specificity was less than 72%. When cancer prevalence was 50%, NB, CT-FNA, and FDG-PET had similar cost-effectiveness.Conclusions. Both NB and CT-FNA diagnostic strategies are more cost-effective than either VATS biopsy or FDG-PET scan to diagnose lung cancer in moderate-to high-risk nodules and resulted in fewer nontherapeutic operations when FDG-PET specificity was less than 72%. An FDG-PET scan for diagnosis of lung cancer may not be cost-effective in regions of the country where specificity is low. (C) 2014 by The Society of Thoracic Surgeons