S. Kops*a (Mr), R. Verhoevena (Dr), R. Vermeulena (Ms), M. Roversa (Prof), E. Van Der Heijdena (Dr), T. Goversa (Dr)

a Radboudumc Nijmegen, Nijmegen, NETHERLANDS

* stephan.kops@radboudumc.nl

Background: Minimal invasive diagnostic procedures of pulmonary nodules have seen significant development in recent years with the advent of navigation bronchoscopy techniques such as cone beam CT-guided navigation bronchoscopy (CBCT-NB). Widespread implementation is however still lacking and CT-guided transthoracic biopsy (TTNB) remains the most utilized diagnostic technique, with high accuracy but also high complication rates (25%). In case of TTNB ineligible patients, treatment without pathologic proof of malignant disease is frequently ensued, risking unnecessary treatment. CBCT-NB can be a valuable alternative but has not been evaluated from a cost-effectiveness standpoint. This model-based study aims to determine if CBCT-NB is a cost-effective procedure in the workup of pulmonary nodules compared to TTNB and direct treatment.

Methods: Two decision analytical models were developed to compare CBCT-NB with TTNB and direct treatment in terms of costs and effects (quality of life). Input data were gathered in-house, from literature, and expert opinion. To assess uncertainty a distribution was modelled around each parameter and sensitivity analyses were performed. The model was run for 5000 iterations while selecting a new input value for each parameter from these distributions for every iteration, resulting in a probabilistic sensitivity analysis (PSA).

Results: CBCT-NB is cost-effective in 73% and 92% of PSA iterations when compared to TTNB, assuming a willingness to pay threshold (WTP) of €20.000 and €80.000. CBCT-NB is cost-effective in 100% of iterations compared to direct treatment at a WTP of €20.000. The minimal required diagnostic accuracy for CBCT-NB to be cost-effective was ~90% vs TTNB and ~65% vs direct treatment. CBCT-NB remained cost-effective compared to direct treatment (without pathology proven disease) until a risk of malignancy >90%.

Conclusions: CBCT-NB can be a cost-effective alternative to TTNB and direct treatment. Direct treatment is seldomly a cost-effective option and a definitive diagnosis before treatment should be pursued if possible.

Disclosure of funding source(s):

Unrestricted research grant by Siemens Healthineers