Cost-Effectiveness Analysis of Transbronchial Needle Aspiration of Pulmonary Lesions Without Endobronchial Affectation

Leiro-Fernández, Virginia; Rial, Maribel Botana; Represas-Represas, Cristina; Piñeiro, Ana González; Pérez, Victor Del Campo; Fernández-Villar, Alberto

doi:10.1016/j.arbr.2012.10.003

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…Out of 2089 articles selected from the electronic databases, 18 studies were eligible for a qualitative and quantitative analysis (figure 1). The pooled sample size included 1687 patients enrolled from 10 countries (USA [7-9, 17, 18], Japan [14,19,20], Italy [4,5], Spain [6,10], Poland [21], Greece [11], Turkey [22], India [12], Norway [23], and Switzerland [13]). Mean±SD age of the population target was 60.4±5.8 years, although data were reported only in eight studies [5-7, 11-14, 22].…”

Section: Resultsmentioning

confidence: 99%

“…BABA [19] BILAÇEROGLU [22] CASTELLA [10] CHECKANI [17] GASPARINI [4] GUPTA [12] IYODA [14] KATIS [11] KAWARAYA [20] LEIRO-FERNÁNDEZ [6] PIROZYNSKI [21] REICHENBERGER [13] ROTH [23] SCHENK [9] SHURE [7] TRISOLINI [5] WANG [8] WANG [ 95% CI 0.0-81.0%) was found when ROSE was not carried out [7,8,10,11,17,18,22,23] 5). When the authors evaluated lesions >3 cm [5,10], the TBNA diagnostic yield was 0.81 (95% CI 0.7-0.9) (I² not available); the pooled proportion was 0.55 (95% CI 0.5-0.6) (I² not available) in cases of lesions ⩽3 cm [5,10] (figure 6).…”

Section: Resultsmentioning

confidence: 99%

“…Data on comparison between TBNA and TBB, resulting only from studies in which both procedures were performed in the same patients, showed a significant superiority of TBNA. Considering that, based on the literature, TBNA is still largely underused while TBB is the most employed technique in this context, this result is of great relevance [1,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the recent introduction of innovative and more powerful imaging-guided techniques, such as endobronchial ultrasounds (EBUSs) and electromagnetic navigation, the lack of resources and specific skills in most centres worldwide have strongly limited their diffusion in clinical practice. As a result, traditional fluoroscopy-guided TBNA still plays a relevant role in this context [6].…”

Section: Introductionmentioning

confidence: 99%

“…A limited number of studies have specifically assessed the diagnostic yield of conventional TBNA in diagnosing PPLs, showing a great heterogeneity in terms of sensitivity [5][6][7][8][9][10][11][12][13][14]. This could be related to differences in study design, as well as to a number of selected other factors, including both baseline clinical characteristics and procedural aspects.…”

Section: Introductionmentioning

confidence: 99%

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Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis

et al. 2016

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Fluoroscopy-guided transbronchial needle aspiration (TBNA) has long been used in the diagnosis of peripheral pulmonary lesions (PPLs), although its diagnostic performance varies considerably.We conducted a systematic review and meta-analysis evaluating the accuracy of TBNA in the diagnosis of PPLs, comparing its diagnostic yield with transbronchial biopsy (TBB) and assessing the main predictors of a successful aspirate.In 18 studies, the overall TBNA yield was 0.53 (95% CI 0.44-0.61). TBNA showed a higher accuracy when directly compared to TBB (0.60 (95% CI 0.49-0.71) versus 0.45 (95% CI 0.37-0.54)). The subgroup analyses documented a higher TBNA yield when the computed tomography (CT) bronchus sign was present (0.70 (95% CI 0.63-0.77) versus 0.51 (95% CI 0.38-0.64)), when rapid on-site evaluation (ROSE) was performed (0.62 (95% CI 0.43-0.79) versus 0.51 (95% CI 0.42-0.60)), in the case of malignant lesions (0.55 (95% CI 0.44-0.66) versus 0.17 (95% CI 0.11-0.24)) and for lesions >3 cm (0.81 (95% CI 0.73-0.87) versus 0.55 (95% CI 0.47-0.63)).Conventional TBNA is a useful sampling technique for the diagnosis of PPL, with a higher diagnostic yield than TBB. The presence of CT bronchus sign, an underlying malignant process, lesion size >3 cm and ROSE employment are predictors of a higher yield.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis

et al. 2016

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A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers

Oosterhoff¹,

Maas²,

Steuten

2015

Appl Health Econ Health Policy

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BackgroundDiagnostic biomarkers have multiple applications along the care process and have a large potential in optimizing treatment decisions. However, many diagnostic biomarkers struggle to gain market access and obtain appropriate coverage because of a lack of evidence on their health economic impact.ObjectivesThe aim was to review the (methodological) characteristics of recent economic evaluations on diagnostic biomarkers and examine whether these studies dealt with specific issues such as different payer perspectives, preference heterogeneity, and multiple applications in subpopulations.MethodsThe PubMed database and the National Health Service Economic Evaluation Database were searched. Full economic evaluations published after 2009 assessing diagnostic biomarkers for the main non-communicable diseases in middle-income or high-income countries were considered eligible. Empirical and methodological study characteristics were summarized, as was the handling of specific issues related to the economic evaluation of personalized medicine.ResultsThirty-three economic evaluations were included, of which 25 were model-based analyses. The number of strategies compared ranged from two to 17 per study, and was especially large in studies assessing genetic testing in patients and their relatives. Cost-effectiveness results were most sensitive to test accuracy and costs of the biomarker (N = 7), the relative risk of an event (N = 4), and the proportion of people accepting genetic testing (N = 2). One study incorporated patient preferences, and none of the studies considered different payer perspectives, cost sharing arrangements or variable opportunity costs due to population density variability.ConclusionsPublished health economic evaluations of biomarkers used for diagnosing, staging diseases, and guiding treatment selection are characterized by a large number of comparators to model the potential clinical applications and to determine their value. Assessing outcomes beyond health as well as specific issues, such as different payer perspectives and patient preferences, is crucial to fully capture the potential health economic impact of diagnostic biomarkers and to inform value-based reimbursement.

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Cryobiopsy in the Diagnosis of Diffuse Interstitial Lung Disease: Yield and Cost-Effectiveness Analysis

Hernández-González¹,

Lucena²,

Ramírez

et al. 2015

Archivos de Bronconeumología (English Edition)

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Cost-Effectiveness Analysis of Transbronchial Needle Aspiration of Pulmonary Lesions Without Endobronchial Affectation

Cited by 4 publications

References 23 publications

Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis

Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis

A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers

Cryobiopsy in the Diagnosis of Diffuse Interstitial Lung Disease: Yield and Cost-Effectiveness Analysis

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