Economic modeling study finds that fine-needle aspiration with rapid evaluation reduces diagnostic costs by 33% in non-small cell lung cancer, highlighting improved safety and efficiency.
Key Points
To evaluate the economic costs and clinical role of fine-needle aspiration (FNA) versus core-needle biopsy (CNB) using an FNA-first pathway with predefined CNB escalation in non-small cell lung cancer.
Synthesized clinical evidence on diagnostic adequacy, adverse complication rates, and molecular testing performance (including PD-L1 and next-generation sequencing) for cytology versus core biopsy tissue.
Constructed a decision-tree and microcosting framework reflecting Sweden's Standardized Cancer Care Pathway for lung cancer to evaluate diagnostic episode costs and sensitivity to parameter changes.
Modern cytology with rapid on-site evaluation achieved a nondiagnostic rate of ≤6% while reliably supporting PD-L1 testing and broad next-generation sequencing with high surgical concordance.
An FNA-first strategy reduced expected per-patient diagnostic episode costs by approximately 33% (7,748 vs. 11,637 Swedish krona) compared with primary CNB, primarily due to fewer major complications.
Cost reductions remained robust across sensitivity analyses testing ±50% variations in complication rates and ±5% to 10% variations in diagnostic adequacy.