Endobronchial ultrasound-guided transbronchial needle aspiration versus mediastinoscopy for mediastinal staging of lung cancer: A systematic review of economic evaluation studies.

João Pedro Steinhauser Motta,Caroliny Samary Lobato,Vanessa Souza Mendonça,Ricardo E Steffen,José Roberto Lapa E Silva

doi:10.1371/journal.pone.0235479

Abstract

The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers. Seven hundred and seventy publications were identified through the database searches. Eight articles were included in this review. All publications are full economic evaluation studies, one cost-effectiveness, three cost-utility, and four cost-minimization analyses. The costs of strategies using EBUS-TBNA were lower than the ones using mediastinoscopy in all studies analyzed. Two of the best quality scored studies demonstrate that the mediastinoscopy strategy is dominated by the EBUS-TBNA strategy. Information gathered in the eight studies of this systematic review suggest that EBUS is cost-effective compared to mediastinoscopy for mediastinal staging of lung cancer.

Highlights

The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer
An important question to be answered at this point is: is the use of EBUS for the mediastinal staging of lung cancer cost-effective when compared to mediastinoscopy? Some economic evaluation studies published in the last 10 years have analyzed the incorporation of the EBUS technique in different health systems [14], but until now the costeffectiveness of EBUS versus mediastinoscopy has not been demonstrated in prior clinical trials
The literature search was divided into 3 parts: 1) Search the PROSPERO platform for systematic reviews on this subject already published or in progress 2) Search in electronic databases: MEDLINE (Pubmed), EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus, National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD) 3) Crossanalysis of the bibliographic references of the articles selected in the database search phase

Summary

Methods

This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Selection of articles, data extraction and quality assessment were carried out by two reviewers. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript

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Material and methods

Procedures costs

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Discussion