Disinvestment. Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging
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Disinvestment. Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging

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Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging. ...

Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging.
A/Professor Richard King
Chair, Victorian Policy Advisory Committee on Technology
Department of Health, Victoria, Australia

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Disinvestment. Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging Disinvestment. Surgical disinvestment: endobronchial ultrasound for lung cancer diagnosis and staging Presentation Transcript

  • Surgical disinvestment:endobronchial ultrasound for lung cancerdiagnosis and stagingA/Professor Richard KingChair, Victorian Policy Advisory Committee on TechnologyDepartment of Health, Victoria, Australia26 June 2012
  • Clinical problem• Detect problems of lungs and mediastinum (e.g. sarcoidosis)• Diagnose lung cancer or lymphoma• Check lymph nodes before considering lung removal surgery to treat lung cancer• Diagnose certain types of infection, especially those that can affect the lungs (e.g. tuberculosis)• Recommend appropriate treatment (e.g. surgery, radiation, chemotherapy) for lung cancer
  • Standard clinical practiceMediastinoscopy:• A surgical procedure to examine the inside of the upper chest between and in front of the lungs (mediastinum)• Used to biopsy lymph nodes in mediastinum to stage and diagnose lung cancer and other conditions• Requires a general anaesthetic and ~2 day hospital stay• Low, but significant, complications (e.g. hospital-acquired infection, collapsed lung, heart and great vessel damage)• Biopsy: Sn 40-80%, Sp %50-100
  • New health technologyEndobronchial ultrasound-guided FNA:• Same day procedure• Can be performed in outpatient setting, not operating theatre (i.e. no surgery required)• Eliminates complications (almost)• Rapid and accurate diagnosis (often same day vs. weeks)• Immediate commencement of treatment• Accurate results reduces need for some lung surgeries
  • EBUS in practice
  • EBUS costsCapital medical equipment:• Ultrasound tower/workstation ($55,000)• EBUS-capable bronchoscope (@ $80,000)Training• Surgeons, physicians, nurses (@ $15,000)Activity• Cost per case (procedure, consumables) @ $2,300
  • EBUS Results• Sensitivity 91%, Specificity 100%• No significant procedure-related complications• Operating theatre time freed up by providing EBUS in outpatient setting• Immediate pathology results: quicker & targeted treatment• Reduced referrals for lung resection surgery• Significant learning curve• Additional costs re maintaining & repairing fragile endoscopes
  • EBUS-driven disinvestmentEBUS has significantly reduced need for mediastinoscopy:• >50% after 12 months (some hospitals report >90%)• 80% after 24 months• 95% after 36 monthsEBUS has significantly reduced need for lung resections:• Frees up operating theatre time and associated hospital costs
  • Return on investment for EBUSSurgical mediastinoscopy ~ $7,300 per procedureHealth department capital investment in EBUS = $400,00090% substitution of surgical mediastinoscopy:• ‘Released savings’ from non-admitted setting per patient ~ $3,000• ‘Released savings’ from non-use of OR per patient ~ $2,100• Total ‘released savings’ per EBUS procedure ~ $5,100• Literature reports per patient cost saving of EBUS cf. surgical mediastinoscopy @ >$5,000‘Released value’ to hospital:• Year 1 > $800,000/year per site; Year 2, @ n=4 sites, > $3.2M/year
  • Health system impact• EBUS is a safe, minimally invasive, cost effective procedure with high sensitivity and specificity for Dx and staging of lung cancer• EBUS procedure costs are adequately funded through casemix• EBUS has had a major impact on clinical practice with almost 100% disinvestment of mediastinoscopy/surgical procedure• Estimated released value of $3.2M per year across four hospitals• Public hospital system investment also driving private patient revenue generation for public hospitals
  • AcknowledgementsDepartment of Health• Dr Paul Fennessy• Ms Suzanne ByersMonash Medical Centre• Dr Michael Farmer, Professor Bill SievertAustin Hospital• Professor Simon Knight, Ms Leanne Turner