Abstract
Rationale: Although previous studies have assessed the clinical or economic value of specific technologies, the economic value of improving sensitivity for malignancy in lung cancer diagnoses broadly across technologies is unclear. Objectives: To identify the economic value of improving sensitivity of bronchoscopy biopsy for the diagnosis of lung cancer. Methods: A decision analytic model was developed to quantify the economic value of increased sensitivity for malignancy for bronchoscopy biopsy of peripheral pulmonary lesions. Primary clinical outcomes included time to diagnosis and survival. Economic outcomes included 1) net monetary benefit (NMB), defined as the health benefits measured in quality-adjusted life-years (QALYs) times willingness to pay ($100,000/QALY) net of changes in medical costs; and 2) incremental cost-effectiveness ratio. A decision tree modeling framework with two Markov module branches was developed. The two Markov modules corresponded to patients with cancer who were 1) diagnosed and treated or 2) undiagnosed and remained untreated. Outcomes were measured from a U.S. payer perspective over 30 years. Results: Improving sensitivity for malignancy by 10 percentage points decreased average time to diagnosis for patients with lung cancer by 0.85 month (4 wk) and increased survival by 0.36 year (19 wk) because of faster treatment initiation. Overall health outcomes improved by 0.20 QALYs per patient. Cost increased by $6,727 per patient primarily through increased treatment costs among those diagnosed with cancer. Increasing sensitivity for malignancy by 10 percentage points improved NMB by $8,729 over 30 years (incremental cost-effectiveness ratio of $34,052), driven largely by improved sensitivity to early-stage cancer (stage-specific NMB, I/II, $19,805; III, $2,101; IV, -$1,438). Forty-two percent of overall NMB ($3,668) accrued within 5 years of biopsy. The relationship between change in sensitivity and NMB was approximately linear (1% vs. 10% sensitivity improvement corresponded to NMB of $885 vs. $8,729). The model was most sensitive to cancer treatment efficacy and follow-up time after a negative result. Conclusions: Increasing sensitivity of malignancy by 10 percentage points resulted in a $8,729 improvement in net economic value. Health systems can use this information when making decisions regarding the value of new bronchoscopy technologies.