PURPOSE: Lung cancer is a common malignancy and the most common cause of cancer related death in the United States. Lung cancer related mortality is highly associated with the stage of lung cancer. There are currently two strategies to sample mediastinal lymph nodes, endobronchial ultrasound (EBUS) and cervical mediastinoscopy (MED). We sought to evaluate the cost effectiveness between EBUS and MED in assessing mediastinal adenopathy in patients with presumed non-small cell lung cancer (NSCLC).
METHODS: We compared three strategies to sample mediastinal lymph nodes: EBUS; MED; and a strategy where if the initial EBUS is negative, proceed to MED. The model was built using DecisionMaker software (BetaTest version 2009.6.1). For the base case, the sensitivity of EBUS and MED was considered equivalent and each was assigned a sensitivity of 80%. Available literature was reviewed to estimate key variables used in the model as well as expected prognoses of different disease states. Assumptions were based on the base case and current practice guidelines. Sensitivity analyses were performed on key variables to determine the effect of each variable on the model.
RESULTS: EBUS is a more effective and less costly strategy for biopsying enlarged mediastinal lymph nodes compared to MED. EBUS followed by MED was also more effective and less costly than MED, however, when compared to EBUS alone it had a marginal CE ratio of $76,060. Sensitivity analyses were performed on all key variables. The cost effectiveness of EBUS was not affected by any of the sensitivity analyses that were performed.
CONCLUSION: EBUS alone or EBUS followed by MED is a cost effective strategy for biopsying enlarged mediastinal lymph nodes in patients with NSCLC.
CLINICAL IMPLICATIONS: From a clinical and cost effectiveness perspective, EBUS should be considered the initial strategy to biopsy mediastinal adenopathy in patients presumed to have NSCLC.
DISCLOSURE: Joseph Seaman, No Financial Disclosure Information; No Product/Research Disclosure Information