Abstract
Background: Few studies have measured both the costs and the effectiveness of different combinations of sampling techniques when bronchoscopies of peripheral lung lesions are evaluated.
Objective: To find the most cost effective combination of sampling techniques for peripheral lung lesions not visible by bronchoscopy.
Methods: 289 patients were included in an open prospective trial performed at the Haukeland University Hospital and Aalesund Hospital in Norway, from June 2005 to January 2008. All sampling techniques (biopsy, brushing, trans-bronchial needle aspiration (TBNA), and washing) were performed in 178 cases (study sample). The costs from the Department of Thoracic Medicine and the Department of Pathology were calculated for each sampling technique. The combined diagnostic yield for benign and malignant disease was the effectiveness measurement. The willingness to pay for one additional positive sample was estimated to be 2800 euro, based on the cost for 5 days in a day ward and the cost of one additional investigation. The combination was cost-effective when the incremental cost-effectiveness ratio (ICER) was below the willingness to pay.
Results: The detection rate for cancer increased from 36.7% for biopsy alone to 43.8% for biopsy and brushing. The ICER was 1211 euro for biopsy and brushing compared to biopsy alone. Addition of washing or TBNA to biopsy and brushing was not cost-effective for peripheral lesions (ICER washing: 4761 euro, ICER TBNA: 8262 euro)
Conclusion: Biopsy and brushing was the most cost-effective combination of sampling techniques for peripheral lesions.
- © 2011 ERS