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Endoscopy 1999; 31(9): 707-711
DOI: 10.1055/s-1999-74
Original Article
Georg Thieme Verlag Stuttgart ·New York

Cost-Efficacy of Endoscopic Ultrasonography with Fine-Needle Aspiration vs. Mediastinotomy in Patients with Lung Cancer and Suspected Mediastinal Adenopathy

L. Aabakken, G. A. Silvestri, R. Hawes, C. E. Reed, V. Marsi, B. Hoffman
  • Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
  • Department of Pulmonary Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  • Department of Thoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Publication History

Publication Date:
31 December 1999 (online)

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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

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