[Evaluation criteria for bronchial carcinoma. Economic criteria in the management of lung cancer]

The economic assessment of treatments or medical strategies has been the subject of an increasing number of publications. The elevated costs and modest efficacy of many treatments for lung cancer are an added impetus to such analyses. This review summarises the principal results of these analyses, the limitations of the methods used and discusses the evaluation of the cost of these cancers to society. The economic assessment of new chemotherapeutic drugs, and the place of cost-effectiveness analysis in randomized trials is also considered. In the final part, we outline future prospects for this area of research and the importance of such considerations for clinicians. These evaluations, which provide complementary data for clinicians when making decisions on therapeutic options, will be adopted more widely in coming years.

[F-18 fluorodeoxyglucose positron emission tomography in lung lesions]

Positron emission tomography (PET) is used in an increasing number of patients for the evaluation of solitary pulmonary nodes as well as for staging and restaging of lung cancer. It adds metabolic information to the anatomical images of CT and may lead to significant cost savings as well in primary diagnostics as in restaging if patients are carefully selected.

[Epidemiology and costs of lung cancer in Germany]

OBJECTIVE

Lung cancer shows the leading incidence of all cancers among men in the developed world and an increasing incidence among women. We performed a cost of illness study that aimed to assess the economic burden of lung cancer in Germany and to identify the main cost drivers.

METHODS

Costs were estimated for the year 1996. In a retrospective analysis we calculated direct and indirect costs based on secondary data from governmental institutions as well as from the pharmaceutical industry. We chose the cost perspective of sickness funds to estimate direct costs. The human capital approach was applied for the calculation of indirect costs.

RESULTS

Total estimated costs were DM 8.31 billion per year. The indirect costs of DM 7.40 billion accounted for 89 % of total estimated costs. The most important cost driver of the indirect costs, early death, represented on its own DM 4.85 billion, according to 58 % of total estimated costs. Of the direct costs, 93 % were due to hospitalization, amounting to DM 0.85 billion.

CONCLUSIONS

This cost of illness study concerning lung cancer illustrates the outstanding importance of the indirect costs, mostly due to early death, for total costs. Based on these findings and on the leading role of smoking in the etiology of lung cancer, we suggest that studies dealing with the net costs of smoking to society should include indirect costs.

Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs. mediastinotomy in patients with lung cancer and suspected mediastinal adenopathy

BACKGROUND AND STUDY AIMS

The use of endoscopic ultrasonography (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has become an important aid in the staging of bronchogenic carcinoma. In many cases, it may be an alternative to mediastinoscopy/mediastinotomy (MED), but the cost-effectiveness of the two techniques has not been compared. The aim of this study was to apply a decision-analysis model to compare the cost-effectiveness of EUS and MED in the preoperative staging of patients with non-small-cell lung cancer.

PATIENTS AND METHODS

A decision-analysis model was designed, taking as entry criteria lung cancer and abnormal mediastinal lymph nodes verified by computerized tomography (CT). Performance characteristics of MED and EUS were retrieved from the published literature, as were life expectancy data. Direct actual costs of the relevant procedures were retrieved from the billing system of our hospital.

RESULTS

The cost per year of expected survival is US$ 1.729 with the EUS strategy, and US$ 2.411 with the MED strategy. The advantage conferred by EUS remains even when the negative predictive value of EUS is as low as 0.22.

CONCLUSION

Because of its low cost and high yield, EUS-guided FNA is a cost-effective aid assessing mediastinal lymphadenopathy.

Is follow-up of lung cancer patients after resection medically indicated and cost-effective?

BACKGROUND

There are no guidelines for the appropriate follow-up of patients after pulmonary resection for lung cancer.

METHODS

Three-hundred fifty-eight consecutive patients who had undergone complete resections of non-small cell lung cancer between 1987 and 1991 were evaluated for tumor recurrence and development of second primary tumors. Recurrences were categorized by site (local or distant), mode of presentation (symptomatic or asymptomatic), treatment given (curative intent or palliative), and duration of overall survival.

RESULTS

Recurrences developed in 135 patients (local only, 32; local and distant, 13; and distant only, 90). Of these, 102 were symptomatic and 33 were asymptomatic (most diagnosed by screening chest roentgenogram). Forty patients received treatment with curative intent (operation or radiation therapy > 50 Gy) and 95 were treated palliatively. The median survival duration from time of recurrence was 8.0 months for symptomatic patients and 16.6 months for asymptomatic patients (p = 0.008). Multivariate analysis shows that disease-free interval (greater than 12 months or less than or equal to 12 months) was the most important variable in predicting survival after recurrence and that mode of presentation, site of recurrence, initial stage, and histologic type did not significantly affect survival. New primary tumors developed in 35 patients.

CONCLUSIONS

Although detection of asymptomatic recurrences gives a lead time bias of 8 to 10 months, mode of treatment and overall survival duration are not greatly affected by this earlier detection. Disease-free interval appears to be the most important determinant of survival. Screening for asymptomatic recurrences in patients who have had lung cancer is unlikely to be cost-effective. Frequent follow-up and extensive radiologic evaluation of patients after operation for lung cancer are probably unnecessary.