Endobronchial ultrasound-guided transbronchial needle aspiration versus mediastinoscopy for mediastinal staging of lung cancer: A systematic review of economic evaluation studies

• Published in: PloS one 2020-06, Vol.15 (6), p.e0235479-e0235479
• Main Authors: Steinhauser Motta, João Pedro, Steffen, Ricardo E, Samary Lobato, Caroliny, Souza Mendonça, Vanessa, Lapa e Silva, José Roberto, Lin, Jules, Groth, Shawn
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Clinical trials; Comparative analysis; Cost analysis; Data bases; Diagnosis; Documents; Economic analysis; Economic impact; Evaluation; Impact analysis; Keywords; Lung cancer; Lung diseases; Mediastinoscopy; Medicine and Health Sciences; Patients; Quality assessment; Quality control; Research and Analysis Methods; Reviews; Social Sciences; Systematic review; Ultrasonic imaging; Ultrasound; Ultrasound imaging
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235479

Introduction The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. Objective The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. Methods This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers. Results Seven hundred and seventy publications were identified through the database searches. Eight articles were included in this review. All publications are full economic evaluation studies, one cost-effectiveness, three cost-utility, and four cost-minimization analyses. The costs of strategies using EBUS-TBNA were lower than the ones using mediastinoscopy in all studies analyzed. Two of the best quality scored studies demonstrate that the mediastinoscopy strategy is dominated by the EBUS-TBNA strategy. Conclusion Information gathered in the eight studies of this systematic review suggest that EBUS is cost-effective compared to mediastinoscopy for mediastinal staging of lung cancer.