Cost-Effectiveness of Initial Diagnostic Strategies for Pulmonary Nodules Presenting to Thoracic Surgeons Stephen A. Deppen, MA, MS, William T. Davis,

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Presentation transcript:

Cost-Effectiveness of Initial Diagnostic Strategies for Pulmonary Nodules Presenting to Thoracic Surgeons Stephen A. Deppen, MA, MS, William T. Davis, BS, Elizabeth A. Green, BS, Otis Rickman, DO, Melinda C. Aldrich, Sarah Fletcher, Joseph B. Putnam, MD, Eric L. Grogan, MD, MPH The Annals of Thoracic Surgery Volume 98, Issue 4, Pages 1214-1222 (October 2014) DOI: 10.1016/j.athoracsur.2014.05.025 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Decision analysis model for patient presenting with a 1.5- to 2-cm nodule and likelihood of lung cancer is 65%. (A = outcomes resulting from a video-assisted thoracoscopic surgery [VATS] biopsy; B = outcomes resulting from a lobectomy given pathologically determined malignancy; CT-FNA = computed tomography-guided fine-needle aspiration; PET = positron emission tomography; SPN = suspicious pulmonary nodule.) The Annals of Thoracic Surgery 2014 98, 1214-1222DOI: (10.1016/j.athoracsur.2014.05.025) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Sensitivity analysis and cost-effectiveness threshold given various combinations of 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET) sensitivity and specificity. Graph displays the most cost-effective treatment across sensitivity and specificity combinations with all other model variables held constant at baseline values. For example, FDG-PET (gold area) is the most cost-effective choice if the sensitivity and specificity of FDG-PET are both 94%. If the sensitivity of FDG-PET is 94% and specificity is 60%, then computed tomography-guided fine-needle aspiration (CT-FNA) or navigation bronchoscopy (blue area) is the most cost-effective strategy. The Annals of Thoracic Surgery 2014 98, 1214-1222DOI: (10.1016/j.athoracsur.2014.05.025) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions