Stephen A Deppen1, William T Davis2, Elizabeth A Green3, Otis Rickman3, Melinda C Aldrich3, Sarah Fletcher3, Joseph B Putnam1, Eric L Grogan4. 1. Tennessee Valley Health System Veterans Affairs, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee. 2. Tennessee Valley Health System Veterans Affairs, Nashville, Tennessee. 3. Vanderbilt University Medical Center, Nashville, Tennessee. 4. Tennessee Valley Health System Veterans Affairs, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: eric.grogan@vanderbilt.edu.
Abstract
BACKGROUND: Patients presenting to thoracic surgeons with pulmonary nodules suggestive of lung cancer have varied diagnostic options including navigation bronchoscopy (NB), computed tomography-guided fine-needle aspiration (CT-FNA), (18)F-fluoro-deoxyglucose positron emission tomography (FDG-PET) and video-assisted thoracoscopic surgery (VATS). We studied the relative cost-effective initial diagnostic strategy for a 1.5- to 2-cm nodule suggestive of cancer. METHODS: A decision analysis model was developed to assess the costs and outcomes of four initial diagnostic strategies for diagnosis of a 1.5- to 2-cm nodule with either a 50% or 65% pretest probability of cancer. Medicare reimbursement rates were used for costs. Quality-adjusted life years were estimated using patient survival based on pathologic staging and utilities derived from the literature. RESULTS: When cancer prevalence was 65%, tissue acquisition strategies of NB and CT-FNA had higher quality-adjusted life years compared with either FDG-PET or VATS, and VATS was the most costly strategy. In sensitivity analyses, NB and CT-FNA were more cost-effective than FDG-PET when FDG-PET specificity was less than 72%. When cancer prevalence was 50%, NB, CT-FNA, and FDG-PET had similar cost-effectiveness. CONCLUSIONS: Both NB and CT-FNA diagnostic strategies are more cost-effective than either VATS biopsy or FDG-PET scan to diagnose lung cancer in moderate- to high-risk nodules and resulted in fewer nontherapeutic operations when FDG-PET specificity was less than 72%. An FDG-PET scan for diagnosis of lung cancer may not be cost-effective in regions of the country where specificity is low.
BACKGROUND:Patients presenting to thoracic surgeons with pulmonary nodules suggestive of lung cancer have varied diagnostic options including navigation bronchoscopy (NB), computed tomography-guided fine-needle aspiration (CT-FNA), (18)F-fluoro-deoxyglucose positron emission tomography (FDG-PET) and video-assisted thoracoscopic surgery (VATS). We studied the relative cost-effective initial diagnostic strategy for a 1.5- to 2-cm nodule suggestive of cancer. METHODS: A decision analysis model was developed to assess the costs and outcomes of four initial diagnostic strategies for diagnosis of a 1.5- to 2-cm nodule with either a 50% or 65% pretest probability of cancer. Medicare reimbursement rates were used for costs. Quality-adjusted life years were estimated using patient survival based on pathologic staging and utilities derived from the literature. RESULTS: When cancer prevalence was 65%, tissue acquisition strategies of NB and CT-FNA had higher quality-adjusted life years compared with either FDG-PET or VATS, and VATS was the most costly strategy. In sensitivity analyses, NB and CT-FNA were more cost-effective than FDG-PET when FDG-PET specificity was less than 72%. When cancer prevalence was 50%, NB, CT-FNA, and FDG-PET had similar cost-effectiveness. CONCLUSIONS: Both NB and CT-FNA diagnostic strategies are more cost-effective than either VATS biopsy or FDG-PET scan to diagnose lung cancer in moderate- to high-risk nodules and resulted in fewer nontherapeutic operations when FDG-PET specificity was less than 72%. An FDG-PET scan for diagnosis of lung cancer may not be cost-effective in regions of the country where specificity is low.
Authors: Benjamin D Kozower; Shubin Sheng; Sean M O'Brien; Michael J Liptay; Christine L Lau; David R Jones; David M Shahian; Cameron D Wright Journal: Ann Thorac Surg Date: 2010-09 Impact factor: 4.330
Authors: Eric L Grogan; Stephen A Deppen; Karla V Ballman; Gabriela M Andrade; Francys C Verdial; Melinda C Aldrich; Chiu L Chen; Paul A Decker; David H Harpole; Robert J Cerfolio; Robert J Keenan; David R Jones; Thomas A D'Amico; Joseph B Shrager; Bryan F Meyers; Joe B Putnam Journal: Ann Thorac Surg Date: 2014-02-25 Impact factor: 4.330
Authors: Amelia W Maiga; Stephen A Deppen; Pierre P Massion; Carol Callaway-Lane; Rhonda Pinkerman; Robert S Dittus; Eric S Lambright; Jonathan C Nesbitt; Eric L Grogan Journal: JAMA Surg Date: 2018-04-01 Impact factor: 14.766
Authors: Amelia W Maiga; Stephen A Deppen; Sarah Fletcher Mercaldo; Jeffrey D Blume; Chandler Montgomery; Laszlo T Vaszar; Christina Williamson; James M Isbell; Otis B Rickman; Rhonda Pinkerman; Eric S Lambright; Jonathan C Nesbitt; Eric L Grogan Journal: JAMA Surg Date: 2018-04-01 Impact factor: 14.766
Authors: Stephen A Deppen; Pierre P Massion; Jeffrey Blume; Ronald C Walker; Sanja Antic; Heidi Chen; Michele M Durkin; L Joseph Wheat; Eric L Grogan Journal: Cancer Epidemiol Biomarkers Prev Date: 2018-10-19 Impact factor: 4.254
Authors: Amelia Maiga; Farhood Farjah; Jeffrey Blume; Stephen Deppen; Valerie F Welty; Richard S D'Agostino; Graham A Colditz; Benjamin D Kozower; Eric L Grogan Journal: Ann Thorac Surg Date: 2019-06-27 Impact factor: 4.330
Authors: Susan K Garwood; Pam ClenDening; Nathanael D Hevelone; Kristin L Hood; Sean Pidgeon; Leonard James Wudel Journal: Lung Cancer Manag Date: 2016-11-29
Authors: Julie A Barta; Claudia I Henschke; Raja M Flores; Rowena Yip; David F Yankelevitz; Charles A Powell Journal: Ann Thorac Surg Date: 2017-03-06 Impact factor: 5.102
Authors: Erik E Folch; Mark R Bowling; Thomas R Gildea; Kristin L Hood; Septimiu D Murgu; Eric M Toloza; Momen M Wahidi; Terence Williams; Sandeep J Khandhar Journal: BMC Pulm Med Date: 2016-04-26 Impact factor: 3.317
Authors: Daniel Franzen; Andreas H Diacon; Lutz Freitag; Pawel T Schubert; Colleen A Wright; Macé M Schuurmans Journal: BMC Pulm Med Date: 2016-04-27 Impact factor: 3.317