Is endobronchial ultrasound cost-effective for beginner? A single-center learning curve analysis

Endobronchial ultrasound (EBUS) has emerged as a widely used minimally invasive method for mediastinal and hilar lymph node sampling. However, in newly established centers, its economic sustainability is questioned due to the learning curve, equipment costs, and procedural requirements. This study aims to evaluate the diagnostic performance, procedure duration, and cost-effectiveness of EBUS compared to conventional methods in a beginner center.

This retrospective study included 200 patients treated between January 2022 and January 2024. Patients were divided into two groups: 100 underwent EBUS and 100 underwent conventional procedures (mediastinoscopy, VATS, thoracotomy). Demographic data, diagnosis rates, procedure times, number of sampled nodes, hospitalization duration, and overall costs were compared. Learning curve assessment was based on changes in procedure time and diagnostic accuracy. Statistical analyses were performed.

There were no significant differences in age or sex between the EBUS and conventional groups. Primary malignancy rate was significantly lower in the EBUS group (49% vs 74%, p = 0.001). EBUS was associated with significantly shorter procedure duration (20.8 min vs 47.9 min, p = 0.001), hospital stay (2.0 days vs 2.98 days, p = 0.001), and procedure cost ($222 vs $467, p = 0.001). The learning curve showed a significant breakpoint at the 40th case, with improvements in diagnostic accuracy and reductions in duration. However, in the first 40 EBUS cases, higher rates of inadequate biopsies, increased need for additional surgical interventions, and two major device failures significantly elevated the average cost to $829 in this subgroup. When device repair and additional surgery costs were included, the mean total cost per patient was similar between the EBUS and conventional groups ($477 vs $467).

Although EBUS may initially seem more costly in newly established centers, the learning curve improves efficiency and diagnostic yield over time, ultimately leading to cost-effectiveness. Considering its minimally invasive nature, outpatient feasibility, and lower complication rates, EBUS should be encouraged in clinical practice, even during the early adoption phase.