Optimizing Diagnostic and Staging Pathways for Suspected Lung Cancer: A Decision Analysis

Area of Science:

• Pulmonology
• Oncology
• Health Economics

Background:

• Optimal diagnostic and staging strategies for lung cancer remain undefined.
• Cost-effectiveness of various diagnostic pathways is a critical consideration.

Purpose of the Study:

• To determine the most cost-effective diagnostic and staging strategies for lung cancer.
• To compare different bronchoscopy techniques and CT-guided biopsy.

Main Methods:

• A decision model evaluated 16 permutations of diagnostic strategies for lung cancer.
• Strategies included bronchoscopy variants (radial EBUS, electromagnetic navigation, convex EBUS with/without ROSE) and CT-guided biopsy (CTBx).
• Outcomes assessed were cost, complications, mortality, time, and N2-3 disease detection, analyzed via sensitivity and cost-effectiveness analyses.

Main Results:

• For peripheral lesions with N0 disease, bronchoscopy strategies were more expensive but had fewer complications than CTBx.
• Convex endobronchial ultrasound with ROSE was more cost-effective than CTBx for central lesions or N1-3 disease.
• Rapid-onsite evaluation (ROSE) consistently improved cost-effectiveness across scenarios.

Conclusions:

• Cost-effective lung cancer diagnosis hinges on nodal stage, lesion location, and specific bronchoscopic techniques, including ROSE.
• Decision-making involves trade-offs between cost, complications, and diagnostic yield, tailored to individual patient profiles and willingness-to-pay thresholds.