Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer A Decision Tree Sensitivity Analysis
Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer A Decision Tree Sensitivity Analysis
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DOI：
10.1097/jto.0b013e3181e8b2e6
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发表时间：
2010-10-01
影响因子：
20.4
通讯作者：
Irving, Louis B.
中科院分区：
文献类型：
--
作者：
Steinfort, Daniel P.;Liew, Danny;Irving, Louis B.
背景：非小细胞肺癌（NSCLC）的准确分期对于最佳治疗至关重要。纵隔淋巴结病的微创病理评估越来越多地被执行。这种方法的成本效益（最小化的医疗费用），与传统的手术方法相比，尚未建立。方法：决策树分析应用于比较下游成本的支气管内超声引导下经支气管针吸（EBUS-TBNA），传统的TBNA，和外科纵隔镜检查。计算是基于来自澳大利亚墨尔本一家主要教学医院的实际患者数据的真实的成本。进行了单因素和双因素敏感性分析，以说明输入参数值的潜在变化。对于基础病例分析，使用EBUS-TBNA进行初步评价与EBUS-TBNA相比，（阴性结果经手术证实）是最具成本效益的方法（AU$2961（阴性结果未经手术证实）（3344美元），常规TBNA（3754美元）和纵隔镜检查（8859美元）。EBUS-TBNA检测疾病的敏感性对成本的影响最大，而纵隔淋巴结转移的患病率决定了手术确认阴性EBUS-TBNA结果是否仍然cost-benefit.Conclusions：我们的研究证实，与传统的手术技术相比，NSCLC的微创分期是成本效益。在所有研究参数中，EBUS-TBNA是NSCLC患者纵隔分期的最具成本效益的方法。
Background: Accurate staging of non-small cell lung cancer (NSCLC) is critical for optimal management. Minimally invasive pathologic assessment of mediastinal lymphadenopathy is increasingly being performed. The cost-benefit (minimization of health care costs) of such approaches, in comparison with traditional surgical methods, is yet to be established.Methods: Decision-tree analysis was applied to compare down-stream costs of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), conventional TBNA, and surgical mediastinoscopy. Calculations were based on real costs derived from actual patient data at a major teaching hospital in Melbourne, Australia. One-and two-way sensitivity analyses were undertaken to account for potential variation in input parameter values.Results: For the base-case analysis, initial evaluation with EBUS-TBNA (with negative results being surgically confirmed) was the most cost-beneficial approach (AU$2961) in comparison with EBUS-TBNA (negative results not surgically confirmed) ($3344), conventional TBNA ($3754), and mediastinoscopy ($8859). The sensitivity of EBUS-TBNA for detecting disease had the largest impact on cost, whereas the prevalence of mediastinal lymph node metastases determined whether surgical confirmation of negative EBUS-TBNA results remained cost-beneficial.Conclusions: Our study confirms that minimally invasive staging of NSCLC is cost-beneficial in comparison with traditional surgical techniques. EBUS-TBNA was the most cost-beneficial approach for mediastinal staging of patients with NSCLC across all studied parameters.