Centre for Health Services Research and Technology Assessment, Institute for Public Health, University of Southern Denmark, Odense, Denmark.
Value Health. 2013 Jan-Feb;16(1):57-65. doi: 10.1016/j.jval.2012.09.007.
To assess the expected costs and outcomes of alternative strategies for staging of lung cancer to inform a Danish National Health Service perspective about the most cost-effective strategy.
A decision tree was specified for patients with a confirmed diagnosis of non-small-cell lung cancer. Six strategies were defined from relevant combinations of mediastinoscopy, endoscopic or endobronchial ultrasound with needle aspiration, and combined positron emission tomography-computed tomography with F18-fluorodeoxyglucose. Patients without distant metastases and central or contralateral nodal involvement (N2/N3) were considered to be candidates for surgical resection. Diagnostic accuracies were informed from literature reviews, prevalence and survival from the Danish Lung Cancer Registry, and procedure costs from national average tariffs. All parameters were specified probabilistically to determine the joint decision uncertainty. The cost-effectiveness analysis was based on the net present value of expected costs and life years accrued over a time horizon of 5 years.
At threshold values of around €30,000 for cost-effectiveness, it was found to be cost-effective to send all patients to positron emission tomography-computed tomography with confirmation of positive findings on nodal involvement by endobronchial ultrasound. This result appeared robust in deterministic sensitivity analysis. The expected value of perfect information was estimated at €52 per patient, indicating that further research might be worthwhile.
The policy recommendation is to make combined positron emission tomography-computed tomography and endobronchial ultrasound available for supplemental staging of patients with non-small-cell lung cancer. The effects of alternative strategies on patients' quality of life, however, should be examined in future studies.
评估肺癌分期替代策略的预期成本和结果，为丹麦国家卫生服务机构提供最具成本效益策略的信息。
为确诊为非小细胞肺癌的患者制定决策树。从纵隔镜检查、内镜或支气管内超声联合针吸活检以及正电子发射断层扫描-计算机断层扫描联合 F18-氟脱氧葡萄糖的相关组合中定义了 6 种策略。没有远处转移和中央或对侧淋巴结受累（N2/N3）的患者被认为是手术切除的候选者。诊断准确性来自文献综述，患病率和生存率来自丹麦肺癌登记处，以及国家平均关税的程序成本。所有参数都以概率形式指定，以确定联合决策不确定性。成本效益分析基于预期成本的净现值和 5 年内累计的生命年数。
在成本效益约为 30,000 欧元的阈值下，发现所有患者都进行正电子发射断层扫描-计算机断层扫描，并通过支气管内超声确认淋巴结受累的阳性发现，这是具有成本效益的。在确定性敏感性分析中，这一结果是稳健的。完美信息的预期价值估计为每位患者 52 欧元，表明进一步的研究可能是值得的。
政策建议是为非小细胞肺癌患者提供正电子发射断层扫描-计算机断层扫描和支气管内超声联合检查，以进行补充分期。然而，未来的研究应该检查替代策略对患者生活质量的影响。
