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.
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L. AabakkenM.D. Ph.D. B.C.
Med. Dept. A
Rikshospitalet
0027 Oslo
Norway
Phone: + 47-22-867611
Email: larsaa@ioks.uio.no