TY - JOUR
T1 - An analysis of multiple staging management strategies for carcinoma of the esophagus
T2 - Computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy
AU - Wallace, Michael B.
AU - Nietert, Paul J.
AU - Earle, Craig
AU - Krasna, Mark J.
AU - Hawes, Robert H.
AU - Hoffman, Brenda J.
AU - Reed, Carolyn E.
N1 - Funding Information:
This work was funded, in part, by a grant from the American Digestive Health Foundation, TAP Pharmaceuticals Outcomes Research Award.
PY - 2002/10/1
Y1 - 2002/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0036796228&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036796228&partnerID=8YFLogxK
U2 - 10.1016/S0003-4975(02)03875-4
DO - 10.1016/S0003-4975(02)03875-4
M3 - Article
C2 - 12400740
AN - SCOPUS:0036796228
SN - 0003-4975
VL - 74
SP - 1026
EP - 1032
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -