Cost-Effectiveness of Early Intervention: Comparison between Intraluminal Bronchoscopic Treatment and Surgical Resection for T₁N₀ Lung Cancer Patients

Abstract

Background: For patients with early-stage lung cancer (ESLC) and severe comorbidities, the cost-effectiveness of early intervention may be reduced by screening and treatment-related morbidity and mortality in addition to the risk for non-cancer-related deaths. Objectives: The use of bronchoscopic treatment (BT) for centrally located ESLC as minimally invasive technique has raised questions whether this approach will be more cost-effective than standard surgical resection in the above-mentioned cohort of patients. Methods: The cost-effectiveness of BT of 32 medically inoperable patients with intraluminal tumor has been compared to a matched control group of surgically treated stage IA cancer patients. Results: Median follow-up after BT for ESLC has been 5 years (range 2–10) versus 6.7 years (range 2–10) for the surgical group. Five patients (16%) developed subsequent primaries/local recurrences after BT versus 4 (12.5%) in the surgical group. The respective percentages of actual survival during follow-up have been 50 and 41%, non-lung-cancer-related death 22 and 31% and lung-cancer-related death 28% in both groups, respectively. So far, the average costs per individual for early management by BT have been Euro 22,638 by surgery, and total expenses have been Euro 209,492 and Euro 724,403, respectively. Conclusions: Despite the worse initial health status of patients treated with BT, actual survival rates and costs for early intervention underscore the superior cost-effectiveness of BT as early intervention in properly selected individuals with ESLC in the central airways.

Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with 18F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study

“…However, the low risk and superior cost-effectiveness of intraluminal bronchoscopic intervention, combined with the inherent risk for malignant transformation of these lesions may lead to the implementation of practical measures not supported by foolproof scientific data (25). This may fuel controversies regarding overdiagnosis and treatment of pseudodiseases (26,27).…”

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

“…Current abilities for accurate TNM staging in the early event of carcinogenesis, together with local intervention (e.g. bronchoscopic treatment), will be implemented increasingly upfront as an alternative to immediate surgical approach at the earliest disease stage [8,10,13,[20][21][22].…”

“…The issue of alternative nonsurgical early intervention should be based on sound oncological considerations, including the analysis of tumour behaviour, cost-effectiveness and QoL [21,22]. Early cancer lesions not involving lymph nodes are amenable for local therapy, thus, it is important to accurately stage local tumour growth.…”

“…Certain individuals with favourable early lesions can be properly identified and a less invasive approach is appropriate in these subjects [13][14][15][16][17][18][19][20]. The time window before microinvasive cancer develops nodal involvement can be exploited by choosing a tailored approach for each particular lesion in the person at risk that better preserves QoL and has superior cost-effectiveness [21,22].…”

Early proximal lung cancer diagnosis and treatment

“…The cost of treatment and follow-up of bronchoscopically treated small stage 1A cancers in inoperable patients was 30% of the cost of standard surgery in matched operable patients in one published cost effectiveness analysis; obviously, surgical procedures are associated with greater morbidity [97].…”