Optimizing diagnostic and staging pathways for suspected lung cancer: a decision analysis

Chest. 2021 Jul 10:S0012-3692(21)01314-3. doi: 10.1016/j.chest.2021.06.065. Online ahead of print.ABSTRACTBACKGROUND: The optimal diagnostic and staging strategy for patients with suspected lung cancer is not known.RESEARCH QUESTION: What diagnostic and staging strategies are most cost-effective for lung cancer?STUDY DESIGN AND METHODS: A decision model was developed using a hypothetical patient with a high probability of lung cancer. Sixteen unique permutations of bronchoscopy with fluoroscopy, radial endobronchial ultrasound (rEBUS), electromagnetic navigation, convex EBUS (cEBUS) with or without rapid-onsite evaluation (ROSE), computed tomography guided biopsy (CTBx) and surgery were evaluated. Outcomes included cost, complications, mortality, time to complete the evaluation, rate of undetected N2-3 disease at surgery, incremental cost-complication ratio (ICCR), and willingness-to-pay (WTP) thresholds. Sensitivity analyses were performed on primary outcomes.RESULTS: For a peripheral lung lesion and radiographic N0 disease, the best bronchoscopy strategy costs $1,694 more than the best CTBx strategy but resulted in fewer complications (risk difference 14%). The additional cost of bronchoscopy to avoid one complication from a CTBx strategy was $12,037. The cost and cumulative complications of bronchoscopy strategies increase compared with CTBx strategies for small lesions. The cost and cumulative complications of bronchoscopy strategies decrease compared with CTBx strategies...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research