Chest
Volume 116, Issue 4, October 1999, Pages 1108-1112
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Bronchoscopy
Nd-YAG Laser vs Bronchoscopic Electrocautery for Palliation of Symptomatic Airway Obstruction: A Cost-Effectiveness Study

https://doi.org/10.1378/chest.116.4.1108Get rights and content

Study objective

To evaluate the cost effectiveness of the Nd-YAG laser and bronchoscopic electrocautery for palliation in patients with symptomatic tumor obstruction.

Design

A retrospective study.

Setting

Bronchoscopy unit of a university hospital.

Patients and intervention

Thirty-one consecutive patients with inoperable non-small cell lung cancer and symptomatic intraluminal tumor underwent bronchoscopic treatment. Dyspnea relief was the primary goal of treatment. Fourteen patients were treated with the Nd-YAG laser and 17 patients with electrocautery.

Measurements and results

Improvement of symptoms was achieved in 70% of patients treated by either Nd-YAG laser or electrocautery. Mean ± SD survival was 8.0 ± 2.5 months after Nd-YAG laser treatment and 11.5 ± 3.5 months after electrocautery. The number of treatment sessions per patient was comparable: Nd-YAG laser, 1.1; electrocautery, 1.2. Duration of hospital stay was longer in patients treated with the Nd-YAG laser (8.4 vs 6.7 days). Average treatment costs, including admission charges, were $5,321 for the Nd-YAG laser and $4,290 for electrocautery. Higher costs in the group treated with the Nd-YAG laser were caused by a longer hospital stay before bronchoscopic treatment. Costs of equipment (electrocautery $6,701 and Nd-YAG laser $208,333), write-offs, maintenance, and repair were not included in this calculation.

Conclusion

Bronchoscopic electrocautery is equally effective but is a less expensive and, in our hospital, a more accessible modality than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.

Section snippets

Materials and Methods

Patients included in this study had centrally located inoperable NSCLC and underwent bronchoscopic treatment between January 1994 and December 1996 because of dyspnea due to tracheobronchial obstruction caused by intraluminal tumor. Between January 1994 and March 1995, the laser (Nd-YAG; Sharplan Lasers, Allendale, NJ) was used; between March 1995 and December 1996, electrocautery was used. We had to use electrocautery (Valleylab; Boulder, CO) because of technical problems with our only Nd-YAG

Results

Thirty-one patients were included: 14 were treated with the Nd-YAG laser and 17 with electrocautery. Patient groups were comparable regarding age, sex, diagnosis, site of obstruction, time after intial diagnosis, and previous and current antitumor therapy (Table 1). General anesthesia was used more often in patients treated with the Nd-YAG laser. Improvement of symptoms was achieved in about 70% of patients in both treatment groups. No complications related to treatment technique were found in

Discussion

Duration of hospital stay was the most important factor determining costs of treatment in our hospital, expressed as the monetary amount of the claim submitted to the health insurance company. No differences in costs of services directly related to bronchoscopic treatment (eg, number of treatment sessions and bronchoscopic sessions) were found. The use of general anesthesia, which was more frequent in the group treated with the Nd-YAG laser, may have been a factor determining the longer

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