PMD5 VALUE of Electromagnetic Navigation Bronchoscopy and Its IMPACT on LUNG Cancer Diagnosis Costs

Abstract

Lung cancers are frequently diagnosed in advanced stages due to late patients’ symptomatology or difficulties accessing solitary lung nodules (SLN). Electromagnetic navigation bronchoscopy (ENB) has shown to be a safe, effective and minimally invasive technique for SLN diagnosis at initial stages. Its use could avoid unnecessary diagnostic surgeries (DS) and complications from other diagnostic techniques, as computed tomography-guided transthoracic needle aspiration (CT-TTNA). This study aims to estimate potential avoidable costs on lung cancer diagnosis when introducing ENB from a Spanish hospital perspective. A cost analysis was developed to calculate the cost associated with DS and pneumothoraxes caused by CT-TTNA, as well as the impact of ENB’s introduction in a tertiary hospital. It was based on a yearly hypothetic cohort of 70 and 50 suspected lung cancer patients for DS and CT-TTNA, respectively. Clinical parameters from Sant Pau´s hospital were used in the base case, while an alternative analysis using data from the literature was also performed. Cost data was extracted from Spanish databases and expressed in €. 7 DS that accounted for a total cost of €57,882 (including surgery and hospital stay costs) could have been avoided if a previous biopsy would have been done. The introduction of ENB versus CT-TTNA resulted in a reduction of 9 pneumothoraxes, associated with €22,170. In the alternative analysis, compared to the base case, a higher rate of avoidable DS was considered, leading to higher potential savings (€185,224). The use of ENB resulted in a reduction of 8 pneumothoraxes (€21,306). Current diagnostic methods for lung cancer have an economic impact on hospitals. ENB facilitates the access and biopsy of SLN at initial stages, which improves clinical practice by avoiding aggressive diagnostic techniques, reducing complications and allowing histological diagnostic in lung cancer in order to indicate the right surgical approach.