Economic evaluation comparing Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and surgical mediastinoscopy for mediastinal staging of lung cancer: a systematic review.

Mediastinal sampling is essential for diagnosing and staging thoracic diseases, particularly non-small cell lung cancer (NSCLC). Traditional mediastinoscopy has been the gold standard; however, Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative. This systematic review compares the economic evaluations of EBUS-TBNA to determine their cost-effectiveness, healthcare resource use, and overall economic impact. A systematic review was conducted following PRISMA guidelines. Databases searched included PubMed and ScienceDirect, using keywords such as "EBUS-TBNA," "mediastinoscopy," and "cost-effectiveness." Inclusion criteria focused on studies evaluating studies comparing EBUS-TBNA with traditional mediastinoscopy, with direct economic comparisons between EBUS-TBNA and traditional mediastinoscopy. Articles published in English within the last 10-15 years were included, covering randomized controlled trials, cohort studies, and economic modeling analyses. Four studies met the eligibility criteria after screening and full-text review. The review revealed that EBUS-TBNA consistently demonstrated lower costs and better cost-effectiveness compared to TMC. In the study by Steinfort et al. [1], EBUS-TBNA reduced costs by AU$5,898 per patient compared to mediastinoscopy. Similarly, Chouaid et al. [2] reported cost savings of €1,450 per patient in France. EBUS-TBNA avoided mediastinoscopy in 80% of cases while maintaining high diagnostic accuracy. Sensitivity analyses confirmed that EBUS-TBNA was the most cost-effective when its sensitivity exceeded 17% and mediastinal lymph node metastases (MLNM) prevalence was below 79%. EBUS-TBNA offers significant economic and clinical advantages over traditional mediastinoscopy. It reduces the need for invasive procedures, minimizing patient risk and healthcare costs. Its combination with diagnostic tools like PET-CT further enhances its value, as seen in Søgaard et al. [3], where this approach yielded the most cost-effective outcomes for NSCLC staging. While most studies relied on modeled populations, the findings are robust across diverse healthcare settings. Limitations include the lack of real-world long-term analyses and variability in healthcare systems. This systematic review highlights that EBUS-TBNA is a cost-effective and clinically valuable alternative to traditional mediastinoscopy for mediastinal sampling. Its integration into clinical practice can improve resource utilization and patient outcomes while significantly reducing healthcare costs. Future research should explore its long-term cost-effectiveness and broader applicability in diverse healthcare settings. EBUS-TBNA represents a critical advancement in the diagnostic staging of thoracic diseases.