Cost-effectiveness analysis of electromagnetic navigation bronchoscopy (ENB) for lung nodules

Introduction: A minimally invasive alternative to surgery is ideal for the initial diagnostic approach in high-risk patients with suspicious pulmonary nodules. Objectives: To determine the cost-effectiveness (C-E) of 3 strategies: ENB alone (ENBA), ENB + thoracotomy (ENBT) if this was unsuccessful, and conventional approach (CA) for the initial diagnosis of lung nodules. Method: Decision tree modelling was used to determine the health direct costs (values in € in 2014) and effectiveness of the 3 strategies: accuracy, quality-adjusted life-year (QALY), and adverse events (AE). The perspective used was that of payer9s view. Discount rate was 0%. Time horizon was 3 months. Costs and ENB parameters were obtained from a private institutional database. Parameters of CA and health utilities were obtained from the literature and calculated by modelling. Results: 180 patients were enrolled: age (66.5±11.2 y/o), male (70.6%), non-smokers (22.8%), suspected cancer (89.4%), use of general anaesthesia (13.3%). Initial and final diagnostic accuracy (50.6% and 81.7%, respectively), confirmed cancer diagnosis in 73.47%. Pneumothorax was the only AE (5%). Costs in € were 1756.6±237.0, 3920.8±237.0 and 4602.9±326.2 for ENBA, ENBT and CA per patient, respectively. C-E ratios per diagnosed case were 3360.8€, 4832.8€, and 4668.3€, for ENBA, ENBT and CA strategies, respectively. Also, costs per QALY were 6826.6€, 21405.6€, and 23256€, for ENBA, ENBT and CA strategies, respectively. In terms of quality of life (QOL), alternative strategies resulted in lower costs with respect to CA. Conclusions: The introduction of ENB is a diagnostic strategy in high-risk patients that results in lower costs and increased QOL.