Combined EBUS Real Time TBNA and Conventional TBNA are the Most Cost-effective Means of Lymph Node Staging

Abstract

Lymph node staging is extremely important for the therapeutic decision in patients suffering from lung cancer. For mediastinal staging in nonsmall cell lung cancer different techniques are available. Most frequently, mediastinoscopy or transbronchial needle aspiration (TBNA) are performed for diagnosis and staging. Endobronchial ultrasound (EBUS) was also introduced for this purpose. In this study, the cost effectiveness of EBUS-guided TBNA and EBUS real time TBNA was compared with standard TBNA and mediastinoscopy. For the 5 different strategies, the actual costs for the procedures of 100 patients were calculated. In the costs analysis, equipment, write-off, personnel, disposable, and costs for histologic and cytologic examination were calculated. The average diagnostic yield for standard TBNA was presumed to be 78%, for EBUS-guided TBNA 85%, and for EBUS real time TBNA 95%. Total costs for standard lymph node staging was 653 EUR/patient, for EBUS staging 720 EUR/patient, for EBUS real time staging 701 EUR/patient, and for mediastinoscopy 1620 EUR/patient. For the combined approach of standard TBNA and EBUS real time TBNA, the total costs were 450 EUR/patient. Standard TBNA combined with EBUS real time TBNA reduces the costs significantly for staging of the mediastinum.