Meta-Analysis
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 26, 2014; 2(3): 127-134
Published online Aug 26, 2014. doi: 10.13105/wjma.v2.i3.127
Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China
Bei Lu, Li-Xin Sun, Xi Yan, Zhen-Zhong Ai, Jin-Zhi Xu
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
Author contributions: This research paper was written by Lu B as the first author under supervision of Xu JZ; Sun LX retrieved and analyzed all medical literatures; Yan X and Ai ZZ prepared the illustrations and the statistical analysis.
Correspondence to: Dr. Jin-Zhi Xu, Department of Thoracic Surgery, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yi yuan Street, Nan gang District, Harbin 150001, Heilongjiang Province, China. 13836027105@139.com
Telephone: +86-451-82576963
Received: February 25, 2014
Revised: May 17, 2014
Accepted: July 18, 2014
Published online: August 26, 2014
Processing time: 212 Days and 1.2 Hours
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 diffusion-weighted 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 unnecessary 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.

Keywords: Solitary pulmonary nodules; Diffusion-weighted Magnetic resonance imaging; Computed tomography-guided automated cutting needle biopsy; Positron emission tomography/computed tomography; Cost effectiveness

Core tip: It has become a major concern how to manage solitary pulmonary nodule (SPN) discovered in the clinical setting with low cost and high accuracy and reduce the morbidity and mortality associated with radiation, biopsy, and surgical procedures. However, up to now there has not been an analysis of cost-effectiveness of various strategies for the diagnosis and management of SPN in China. Recent studies in other countries may not hold true in a Chinese hospital because of differences in health-care systems and diagnostic strategy. We are the first to perform such an analysis for the cost-effective management of solitary pulmonary nodules in China.