Barts Thorax Centre, Barts Health NHS Trust, London, London, UK.
York Health Economics Consortium, Heslington, North Yorkshire, UK.
BMJ Open Respir Res. 2020 Aug;7(1). doi: 10.1136/bmjresp-2020-000595.
Lung cancer is accountable for 35 000 deaths annually, and prognosis is improved when the cancer is diagnosed early. CT-guided biopsy (transthoracic needle aspiration, TTNA) and electromagnetic navigation bronchoscopy (ENB) can be used to investigate indeterminate pulmonary nodules if the patient is unfit for surgery. However, there is a paucity of clinical and health economic evidence that directly compares ENB with TTNA in this population group. This cost-effectiveness study aimed to explore potential scenarios whereby ENB may be considered cost-effective when compared with TTNA.
A cohort decision analytic model was developed using a UK National Health Service perspective. ENB was assumed to have equal sensitivity to TTNA at 82%. Lifetime costs and quality-adjusted life-year (QALY) gain were calculated to estimate the net monetary benefit at a £20 000 per QALY threshold. Sensitivity analyses were used to explore scenarios where ENB could be considered a cost-effective intervention.
Under the assumption that ENB has equal efficacy to TTNA, ENB was found to be dominant (less costly and more effective) when compared with TTNA, due to having a reduced risk and cost of adverse events. This conclusion was most sensitive to changes in the cost of intervention, estimates of effectiveness and adverse event rates.
ENB is expected to be cost-effective when the likelihood of an accurate diagnosis is equal to (or better than) TTNA, which may occur in certain subgroups of patients in whom TTNA is unlikely to accurately diagnose malignancy or when an experienced practitioner achieves a high accuracy with ENB.
肺癌每年导致 35000 人死亡，早期诊断可改善预后。如果患者不适合手术，CT 引导下活检（经胸针吸活检，TTNA）和电磁导航支气管镜（ENB）可用于检查不确定的肺结节。然而，在这一人群中，直接比较 ENB 与 TTNA 的临床和健康经济证据很少。本项成本效益研究旨在探讨在哪些情况下，与 TTNA 相比，ENB 可能具有成本效益。
使用英国国家医疗服务体系的观点，开发了一个队列决策分析模型。假设 ENB 与 TTNA 的敏感性相同，为 82%。计算终身成本和质量调整生命年（QALY）增益，以估计在 20000 英镑/QALY 阈值下的净货币收益。进行敏感性分析以探讨 ENB 可能被视为具有成本效益的干预措施的情况。
在假设 ENB 与 TTNA 具有相同疗效的情况下，与 TTNA 相比，ENB 具有优势（成本更低且效果更好），因为它具有降低不良事件的风险和成本。这一结论对干预成本、有效性估计和不良事件发生率的变化最为敏感。
当准确诊断的可能性与 TTNA 相等（或更好）时，ENB 预计具有成本效益，这可能发生在 TTNA 不太可能准确诊断恶性肿瘤的某些特定患者亚组中，或者当经验丰富的医生使用 ENB 获得高准确性时。
