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Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer: A Decision Tree Sensitivity Analysis  Daniel P. Steinfort, MBBS, FRACP, Danny.

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Presentation on theme: "Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer: A Decision Tree Sensitivity Analysis  Daniel P. Steinfort, MBBS, FRACP, Danny."— Presentation transcript:

1 Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer: A Decision Tree Sensitivity Analysis  Daniel P. Steinfort, MBBS, FRACP, Danny Liew, MBBS, FRACP, PhD, Matthew Conron, MBBS, FRACP, Anastasia F. Hutchinson, PhD, Louis B. Irving, MBBS, FRACP  Journal of Thoracic Oncology  Volume 5, Issue 10, Pages (October 2010) DOI: /JTO.0b013e3181e8b2e6 Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

2 FIGURE 1 Decision tree illustrating possible clinical pathways following selection of one of the four diagnostic approaches being evaluated. MLNM, mediastinal lymph node metastates (MLNM+ = metastases present, MLNM− = metastases absent). Procedures are denoted as positive (+) or negative (−) for metastases. EBUS, endobronchial ultrasound; TBNA, transbronchial needle aspiration. □: Decision node, i.e., the clinician may choose any clinical pathway for an individual patient. ○: Chance node, i.e., patients may experience either outcome, based on chance. The proportion of patients following each pathway from a chance node is dependent on predefined clinical parameters. For example, the proportion of patients following the MLNM+ branch, versus the MLNM− branch, is dependent on the underlying prevalence of MLNM. ▹: Terminal node in decision pathway, i.e., an individual patient has reached a definitive outcome in their diagnostic pathway. Journal of Thoracic Oncology 2010 5, DOI: ( /JTO.0b013e3181e8b2e6) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

3 FIGURE 2 Graphical representation of effect on expected value of each diagnostic pathway during one-way sensitivity analysis with variation in prevalence of lymph node metastases among the modeled population. Surgical confirmation of negative EBUS-TBNA results is cost-beneficial above a MLNM prevalence of This figure illustrates the effect of variation in prevalence of MLNM of the modeled population on the overall cost of each specific diagnostic pathway. Journal of Thoracic Oncology 2010 5, DOI: ( /JTO.0b013e3181e8b2e6) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

4 FIGURE 3 Graphical representation of effect on expected value of each diagnostic pathway during one-way sensitivity analysis with variation in sensitivity of EBUS-TBNA. Journal of Thoracic Oncology 2010 5, DOI: ( /JTO.0b013e3181e8b2e6) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

5 FIGURE 4 Two-way sensitivity analysis with variation in prevalence of lymph node metastases and sensitivity of EBUS-TBNA. The most cost-beneficial diagnostic pathway for the combination of the two varied parameters is indicated by the pattern present on the graph. Across all parameter values for MLNM prevalence, and sensitivity of EBUS-TBNA examined, EBUS-TBNA remained the most cost-beneficial diagnostic modality, therefore mediastinoscopy and conventional TBNA are not represented in this graph. The value of surgical confirmation of negative results varied according to parameter values, as demonstrated. Journal of Thoracic Oncology 2010 5, DOI: ( /JTO.0b013e3181e8b2e6) Copyright © 2010 International Association for the Study of Lung Cancer Terms and Conditions

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