An analysis of multiple staging management strategies for carcinoma of the esophagus: Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy

Michael B. Wallace, Paul J. Nietert, Craig Earle, Mark J. Krasna, Robert H. Hawes, Brenda J. Hoffman, Carolyn E. Reed

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

Background. This study compares the health care costs and effectiveness of multiple staging options for patients with esophageal cancer. Techniques studied included computed tomographic (CT) scan, endoscopic ultrasound with fine-needle aspiration biopsy (EUS-FNA), positron emission tomography (PET), thoracoscopy/laparoscopy, and combinations of these. Methods. A decision-analysis model was constructed to compare different staging strategies. Costs were derived from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases and from other Medicare reimbursement rates. Life expectancies were obtained from the 1973-1996 SEER database and adjusted for quality of life. Cost and effectiveness measures were discounted at 0% and 3% per year. Sensitivity and specificity measures were obtained from the published literature and a parallel prospective clinical trial, and all key variables were subjected to sensitivity analyses. Results. Under baseline assumptions, CT + EUS-FNA was the most inexpensive strategy and offered more quality-adjusted life-years, on average, than all other strategies with the exception of PET + EUS-FNA. The latter was slightly more effective but also more expensive. The marginal cost-effectiveness ratio for PET + EUS-FNA was $60,544 per quality-adjusted life-year. These findings were robust and changed very little in all of the sensitivity analyses. Conclusions. The combination of PET + EUS-FNA should be the recommended staging procedure for patients with esophageal cancer, unless resources are scarce or PET is unavailable. In these instances, CT + EUS-FNA can be considered the preferred strategy.

Original languageEnglish (US)
Pages (from-to)1026-1032
Number of pages7
JournalAnnals of Thoracic Surgery
Volume74
Issue number4
DOIs
StatePublished - Oct 1 2002
Externally publishedYes

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Thoracoscopy
Fine Needle Biopsy
Positron-Emission Tomography
Laparoscopy
Esophagus
Tomography
Carcinoma
Cost-Benefit Analysis
Quality-Adjusted Life Years
Esophageal Neoplasms
Medicare
Epidemiology
Databases
Costs and Cost Analysis
Decision Support Techniques
Life Expectancy
Health Care Costs
Quality of Life
Clinical Trials
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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An analysis of multiple staging management strategies for carcinoma of the esophagus : Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. / Wallace, Michael B.; Nietert, Paul J.; Earle, Craig; Krasna, Mark J.; Hawes, Robert H.; Hoffman, Brenda J.; Reed, Carolyn E.

In: Annals of Thoracic Surgery, Vol. 74, No. 4, 01.10.2002, p. 1026-1032.

Research output: Contribution to journalArticle

Wallace, Michael B. ; Nietert, Paul J. ; Earle, Craig ; Krasna, Mark J. ; Hawes, Robert H. ; Hoffman, Brenda J. ; Reed, Carolyn E. / An analysis of multiple staging management strategies for carcinoma of the esophagus : Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. In: Annals of Thoracic Surgery. 2002 ; Vol. 74, No. 4. pp. 1026-1032.
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AU - Earle, Craig

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