EBUS and economic evaluation studies: A literature review

Abstract

Introduction: The emergence of EBUS changed the mediastinal evaluation of lung cancer. Incorporation of this method by health systems may lead to a shift in clinical and costs outcomes. Objective: Provide an overview of economic evaluation studies comparing EBUS to mediastinoscopy and the impact of their implementation in different scenarios. Methods: Literature search performed in Medline, Embase, Web of Science, Cochrane Library of Trials and Lilacs. A search strategy consisting of index terms related to EBUS and economic evaluation studies was built. Studies were screened based on title and abstract. Inclusion criteria were: English, German, Spanish or Portuguese language; full original articles; economic evaluation studies of mediastinal staging strategies. Studies were excluded if the use of EBUS and staging of lung cancer were not the focus of the evaluation. Remaining articles were assessed for eligibility based on full-text. Results: Search strategy found 116 publications and 16 articles were selected. Thirteen studies concluded that the EBUS strategy was more cost-effective than mediastinoscopy. Studies where EBUS had higher costs than mediastinoscopy were those where EBUS was performed in operating room. Two randomized trials showed that an endosonographic approach is cost-effective and should be used early in the investigation. Local EBUS sensitivity and pre-test probability of N2 disease can help decide if it should be the first staging test and if a negative EBUS should be surgically confirmed. Just one study brings data from low and middle-income countries, which reinforces the importance of conducting economic evaluation studies in these locations. Conclusion: Literature suggests that EBUS staging is cost-effective.