Comparing performance and cost of EBUS-TBNA versus other methods for diagnosis and staging of non-small cell lung cancer (NSCLC)

Background :Endobronchial ultrasound (EBUS) is the best first diagnostic tool to obtain tissue and for accurate mediastinal staging. Its cost has yet to be compared to other methods. This has implications on health policy and planning. Aim :To compare the performance characteristics and costs of EBUS-Transbronchial Needle Aspiration (TBNA) for diagnosis and staging with other modalities i.e. EBUS-Transbronchial lung biopsy (TBLB) and Positron Emission Tomography (PET) or transthoracic needle aspiration (TTNA) and PET. Methods :Retrospective analysis of EBUS-TBNA performed from August 2008 to June 2013 at our hospital was done. All patients with NSCLC were included. Final diagnoses and staging were determined by EBUS-TBNA, TTNA-PET, TBLB-PET or surgery. Sensitivity, specificity and accuracy were determined. Calculations were based on real costs derived from actual patient data. Decision analytic models were developed to evaluate the cost effectiveness of EBUS-TBNA compared to other modalities. Results :297 patients with NSCLC were diagnosed during this period. The sensitivity of EBUS-TBNA for accurate mediastinal staging was 85.8%. The overall complication rate was 6%, all minor. The sensitivity of TTNA was 92%, with complication rate of 45.5% (6.8% major) and the sensitivity of EBUS-TBLB was 62.8%, with complication rate of 2.5 %. Using the abovementioned model, the overall costs were S$2837, S$6790 and S$8395 for EBUS-TBNA, TTNA-PET and EBUS-TBLB-PET respectively. Conclusion :EBUS-TBNA has high diagnostic accuracy and results in cost savings of up to S$5558(€3473) per patient. It is the preferred modality for the staging and diagnosis of NSCLC.