Introduction The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. Objective The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. Methods This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers.

Background:Lung cancer is a major health problem, with estimates of 1.6 million tumor-related deaths annually worldwide. The emergence of endobronchial ultrasound (EBUS), a minimally invasive procedure capable of providing valuable information for primary tumor diagnosis and mediastinal staging, significantly changed the approach of pulmonary cancer, becoming part of the routine mediastinal evaluation of lung cancer in developed countries. Some economic evaluation studies published in the last 10 years have already analyzed the incorporation of the EBUS technique in different health systems. The aim of this systematic review is to synthesize the relevant information brought by these studies to better understand the economic effect of the implementation of this staging tool.Methods:The systematic review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Eletronic databases (Medline, Lilacs, Embase, Cochrane Library of Trials, Web of Science, Scopus, National Health System Economic Evaluation Database) will be searched for full economic analyses regarding the use of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) compared to the surgical technique of mediastinoscopy for the mediastinal staging of lung cancer. Two authors will perform the selection of studies, data extraction, and the assessment of risk of bias. Occasionally, a senior reviewer will participate, if necessary, on study selection or data extraction.Results:Results will be published in a peer-reviewed journal.Conclusion:This review may influence a more cost-effective mediastinal staging approach for patients with lung cancer around the world and help health decision makers decide whether the EBUS-TBNA technique should be incorporated into their health systems and how to do it efficiently.Protocol Registry:PROSPERO 42019107901.

Increased plasma total cholesterol (TC) and LDL-cholesterol (low-density lipoprotein) are considered risk factors for coronary disease. Phytosterols are among the dietary options for decreasing serum concentrations of TC and LDL-c by up to 15%.To evaluate the scientific evidence on the use of phytosterols in the treatment of hypercholesterolemia in adults.A systematic meta-analysis of the Medline, Embase, Web of Service, VHL, PUBMED, Scopus, Cochrane Library and LILACS databases was performed between November and December 2016. The PICO strategy was used. Inclusion criteria were randomized clinical trials with adults of both sexes using phytosterols longer than 4 weeks intervention. Exclusion criteria were animal and in vitro studies, humans less than 18 years old and individuals with other diseases (cancer, metabolic syndromes, diabetes mellitus, hypertension, renal disease, liver diseases). The risk of bias was assessed by two reviewers. The primary outcomes investigated were TC and LDL-cholesterol. Statistical analyses were conducted using the RevMan 5.3. The standardized effect size was used to estimate the standardized mean difference and 95% CI of TC and LDL-c.Twenty-seven randomized controlled trials were included in this systematic review and 26 studies in the meta-analysis of TC and LDL-cholesterol. The meta-analyzes showed an association with the reduction in plasma TC (-2.54 [-3.04; -2.03]) and LDL-c (-2.8 [-2.63; -1.53]) after intervention with the vegetable esters.The consumption of 1.5 to 2.0 g/day of phytosterols promotes reduction of TC and LDL-c in hypercholesterolemic individuals, regardless of the way they are consumed.