Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction - A cost-effectiveness study

Study objective: To evaluate the cost effectiveness of the Nd-YAG laser and bronchoscopic electrocautery for palliation in patients with symptomatic tumor obstruction. Design: A retrospective study. Setting: Bronchoscopy unit of a university hospital. Patients and intervention: Thirty-one consecutive patients with inoperable non-small cell lung cancer and symptomatic intraluminal tumor underwent bronchoscopic treatment. Dyspnea relief was the primary goal of treatment. Fourteen patients were treated with the Nd-YAG laser and 17 patients with electrocautery. Measurements and results: Improvement of symptoms was achieved. in 70% of patients treated by either Nd-YAG laser or electrocautery. Mean +/- SD survival was 8.0 +/- 2.5 months after Nd-YAG laser treatment and 11.5 +/- 3.5 months after electrocautery. The number of treatment sessions pel patient was comparable: Nd-YAG laser, 1.1; electrocautery, 1.2. Duration of hospital stay was longer in patients treated with the Nd-YAG laser (8.4 vs 6.7 days). Average treatment costs, including admission charges, were $5,321 for the Nd-YAG laser and $4,290 for electrocautery. Higher costs in the group treated with the Nd-YAG laser were caused by a longer hospital stay before bronchoscopic treatment. Costs of equipment (electrocautery $6,701 and Nd-YAG laser $208,333), write-offs, maintenance, and repair were not included in this calculation. Conclusion: Bronchoscopic electrocautery is equally effective but is a less expensive and, in our hospital, a more accessible modality than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.