Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China |
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Authors: | Bei Lu Li-Xin Sun Xi Yan Zhen-Zhong Ai Jin-Zhi Xu |
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Institution: | Bei Lu, Li-Xin Sun, Xi Yan, Zhen-Zhong Ai, Jin-Zhi Xu, Department of Thoracic Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China |
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Abstract: | AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy. |
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Keywords: | Solitary pulmonary nodules Diffusion-weighted Magnetic resonance imaging Computed tomography-guided automated cutting needle biopsy Positron emission tomography/computed tomography Cost effectiveness |
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