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Endosonography More Cost-Effective Than Surgical Staging in Lung Cancer

Reuters Health • The Doctor's Channel Newscast

NEW YORK (Reuters Health) – A European study indicates that starting with endosonography for assessing mediastinal lymph node status in potentially resectable lung cancer is more cost-effective than immediate surgical staging – at least in the UK, The Netherlands and Belgium where the study was performed.

Furthermore, “In all three countries, the endosonography strategy had slightly higher quality-adjusted life years over 6 months,” the researchers report.

The findings come from a health-economics analysis of data from the ASTER trial, in which 241 patients with suspected or confirmed non-small-cell lung cancer were randomized to surgical mediastinal staging or to a staging strategy combining endobronchial-endoscopic ultrasound with surgical staging if endosonography was negative.

In a previous study, the authors reported that the sensitivity for detecting mediastinal nodal metastases was 79% with surgical staging and 94%with the endosonography approach.  Corresponding negative predictive values were 86% and 93%.

The current study, published in Thorax online September 2, reports on survival, quality of life and cost-effectiveness up to 6 months with the two approaches.

Dr. Linda D. Sharples, with the Institute of Public Health, in Cambridge, UK, and colleagues found that survival was similar in the two arms, with 9 deaths occurring within 6 months in the endosonography group and 11 in the surgical staging group.

Based on responses to the EuroQoL questionnaire, effects on quality of life were similar with endosonography and surgical staging.  When combined with survival there was a small difference in quality-adjusted survival amounting to 0.015 QALYs over 6 months favoring endosonography.

Resource costs varied in each country, but the authors found some consistent patterns and in all countries there was a mean cost saving with endosonography versus surgical staging.

The probability that endosonography was cost-effective compared to surgical staging (at a cost-effectiveness threshold of zero additional euros) was 55% in the Netherlands, 60% in Belgium, and 82% in the UK, Dr. Sharples and colleagues report.

Summing up, they conclude, “Despite differences in patient management and costing between countries, the endosonography strategy was cheaper and had slightly higher mean QALY in all three countries.”

SOURCE: Cost effectiveness of endosonography versus surgical staging in potentially resectable lung cancer: a health economics analysis of the ASTER trial from a European perspective
Thorax 2013.