Endobronchial Ultrasonography Versus Mediastinoscopy: A Single-Institution Cost Analysis and Waste Comparison

Andrade, Rafael S.; Podgaetz, Eitan; Rueth, Natasha M.; Majumder, Kaustav; Hall, Eric; Saric, Crystal; Thelen, Lynn

doi:10.1016/j.athoracsur.2014.04.104

Cited by 17 publications

(11 citation statements)

References 19 publications

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“…The artificial airway requires the use of the OR in most instances as the majority of the bronchoscopy suites are not equipped for GA, and this might increase significantly the cost and affect the availability and the work flow. The cost of EBUS in OR is comparable to mediastinoscopy [20].…”

Section: Discussionmentioning

confidence: 99%

Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration

et al. 2019

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Background and Objectives. The ideal type of sedation for endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is not known. Two previous studies comparing the diagnostic yield between moderate sedation (MS) and deep sedation/general anesthesia (DS/GA) had provided conflicting results with one study clearly favoring the latter. No study had addressed cost. This is concerning for pulmonologists without routine access to anesthesia services. Our objective was to assess the impact of MS and Monitored Anesthesia Care (sedation administered and monitored by an anesthesiologist) on the outcomes and cost of EBUS-TBNA. Materials and Methods. We performed a retrospective review of prospectively collected data on consecutive EBUS-TBNA performed under two different types of sedation in a single academic center. A diagnostic TBNA was defined as an aspirate yielding any specific diagnosis or if subsequent surgery or follow-up of nondiagnostic/normal aspirates showed no pathology. Current Medicare time-based allowances were used for professional charges calculation. Results. There was no difference observed between MS and MAC in regards of the diagnostic yield (92.9% versus 91.9%), procedure duration, number, location, and size of lymph node (LN) sampled, but there were more passes per LN with MAC. The average charges were 74.30 USD for MS and 319.91 for MAC. There were more hypotensive and desaturations episodes with MAC but none required escalation of care. Conclusions. When performed under MS, EBUS-TBNA has similar diagnostic yield as under MAC but may be associated with less side effects. The difference in sedation cost is modest; however, an additional 245$ for each EBUS done under MAC would have significant cost implications on the health system. These findings are of critical importance for bronchoscopists without routine access to anesthesia services and for optimization of healthcare cost and resource utilization.

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Section: Discussionmentioning

confidence: 99%

Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration

et al. 2019

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“…Recent study showed that if the EBUS-TBNA sensitivity of at least 25% cannot be achieved, Med should be the preferred staging strategy. Cost comparison between Med and EBUS-TBNA showed that the needle based technique is less expensive than Med if the staging procedure is performed in the endoscopy suite while it is more expensive than Med if performed in the operating room, however, it generates less waste than Med (75,81).…”

Section: Cost-effectiveness Of Ebus-tbna and Med In Mediastinal Ln Stmentioning

confidence: 99%

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Czarnecka‐Kujawa¹,

Yasufuku²

2017

J. Thorac. Dis.

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This review provides an update on the current role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and mediastinoscopy (Med) in assessment of patients with non-small cell lung cancer (NSCLC). Invasive mediastinal lymph node (LN) staging is the major application for both of these techniques. Up until recently, Med was the gold standard for invasive mediastinal LN staging in NSCLC. However, EBUS-TBNA has shown to be equivalent, and in some studies better than Med for invasive staging of lung cancer. EBUS-TBNA offers access to N1 LNs and development of the thin convex probe EBUS (TCP-EBUS) will expand EBUS-TBNA access from the paratracheal region and central airways to more distal parabronchial regions allowing for more extensive N1 LN assessment and sampling more distal lung tumors. EBUS-TBNA is more cost-effective than Med and it is currently recommended as the test of first choice for invasive mediastinal LN staging in lung cancer. ConfirmatoryMed should be performed selectively in patients with high pretest probability of metastatic disease. Addition of esophageal ultrasound fine needle aspiration (EUS-FNA) may increase diagnostic yield of EBUS-TBNA mediastinal staging. Both Med and EBUS-TBNA can be used in primary lung cancer diagnosis, restaging of the mediastinum following neoadjuvant therapy and in diagnosis of lung cancer recurrence. In the future, a combination of EBUS-TBNA with or without EUS-FNA and Med is most likely going to provide the most optimal invasive assessment of the mediastinum in patients with lung cancer. The decision on test choice and sequence should be made on a case-by-case basis and factoring in local resources and expertise.

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“…Higher than mediastinoscopy, cost of EBUS-TBNA performed in the operating room is consistent with prior literature. 28 However, EBUS-TBNA performed under conscious sedation is effective, safe, and associated with high patient satisfaction. [29][30][31] We hope the results of our study encourage clinicians performing EBUS-TBNA under general anesthesia in an operating room to change their practice.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these situations is expected to increase the per-procedure cost. 28 In contrast, lower costs might be expected if mediastinal staging is performed as a part of a 2-stage procedure with EBUS-TBNA and/or mediastinoscopy followed by a surgery if the MLNS is negative.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of mediastinal lymph node staging in non–small cell lung cancer

Czarnecka‐Kujawa

Rochau²,

Siebert

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Endobronchial Ultrasonography Versus Mediastinoscopy: A Single-Institution Cost Analysis and Waste Comparison

Cited by 17 publications

References 19 publications

Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration

Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Cost-effectiveness of mediastinal lymph node staging in non–small cell lung cancer

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