PURPOSE: Over the past decade, endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has emerged as a safe and accurate modality for the diagnosis of mediastinal pathology. Blind TBNA has a low diagnostic yield and therefore patients frequently require additional surgical procedures for diagnosis. We compared the true costs of EBUS-TBNA to blind-TBNA in the diagnosis of mediastinal or hilar lymphadenopathy.
METHODS: We performed a retrospective chart review of patients who underwent workup of mediastinal or hilar lymphadenopathy at a large academic hospital. All patients initially underwent bronchoscopy and were referred for surgical biopsy at the discretion of the treating physician. We included all bronchoscopic and diagnostic surgical procedures in the analysis. Final diagnosis was based on cytology, surgical results, and/or resolution/non-progression of imaging abnormality. We defined a negative pathologic result as the presence of lymphoid tissue without other abnormal tissue. A non-diagnostic result was defined by the absence of lymphoid or other abnormal tissue. CPT codes (EBUS and blind TBNA) or ICD-9CM and Medicare DRG reimbursement (surgical procedures) were used to determine procedure costs. The per procedure cost included the total cost of all procedures divided by the number of patients analyzed in each group.
RESULTS: 168 patients had an EBUS-TBNA and 37 had blind-TBNA. More lymph nodes were sampled per patient in the EBUS-TBNA group (1.79 vs. 1.24). There was only one complication in each group. The diagnostic yield for EBUS-TBNA was higher (86.9% vs. 59.5%). Fewer patients in the EBUS-TBNA group underwent diagnostic surgical procedures (11.3% vs. 24.3%). A higher percentage of the surgical procedures in the EBUS-FNA group involved lung resection or lobectomy (42.11% vs. 33.33%). The estimated cost savings of EBUS of TBNA was $787.81 per procedure ($1820.95 vs. $2608.76).
CONCLUSION: EBUS-TBNA is less expensive than blind-TBNA in the diagnosis of mediastinal and hilar lymphadenopathy when accounting for necessary surgical procedures.
CLINICAL IMPLICATIONS: Widespread utilization of EBUS can be viewed a cost saving measure.
DISCLOSURE: Daniel Grove, No Financial Disclosure Information; No Product/Research Disclosure Information