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Adrenal Mass Evaluation in Patients with Lung Carcinoma

A Cost-Effectiveness Analysis

¹ Division of Radiology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195-5103.
² Departments of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, OH 44195-5103.
³ Department of Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195-5103.
⁴ Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195-5103.

OBJECTIVE. This study evaluates the cost-effectiveness of various imaging and biopsy strategies for characterizing adrenal masses in patients with newly diagnosed non-small cell carcinoma of the lung.

MATERIALS AND METHODS. A decision-analysis model was used to compare the cost-effectiveness of nine strategies. Initial imaging included unenhanced CT using an adenoma or nonadenoma threshold of 0 or 10 H or in- and opposed-phase MR imaging. When initial imaging did not confirm an adenoma, CT-guided biopsy or subsequent imaging was performed. Medicare reimbursement was used as a surrogate of cost. Net costs were calculated as the difference in costs between two limbs of the decision tree. Net benefits were calculated as the difference between strategies and were calculated for life expectancy in years. MR imaging, CT, and biopsy accuracy, average life expectancy, and surgical mortality rates were based on the literature.

RESULTS. The base case analysis determined that the most cost-effective strategy was CT with an adenoma or nonadenoma threshold of 10 H followed by MR imaging, if necessary. CT with a threshold of 0 H followed by biopsy, if necessary, was the least costly. The incremental cost-effectiveness ratio between these two strategies was $16,370 per year of life gained.

CONCLUSION. Unenhanced CT using a 10 H threshold followed by MR imaging, if needed, was the most cost-effective strategy for evaluating an adrenal mass in a patient with newly diagnosed non-small cell lung cancer.

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