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March 2, 2011

Mediastinal Staging Procedures in Non–Small Cell Lung Cancer—Reply

JAMA. 2011;305(9):890-891. doi:10.1001/jama.2011.225

In Reply: Dr Pramesh and colleagues share our conclusion that the incorporation of endosonography (both EUS-FNA and EBUS-TBNA) into the staging algorithm for locally advanced NSCLC improves staging and patient care. However, they identify several barriers that could hinder implementation.

First, they argue that the cost of endosonography equipment and consumables may be an obstacle that limits availability. Although we acknowledge that these direct costs are an issue, more relevant is the cost-effectiveness of endosonography in relation to surgical staging techniques. In a decision tree sensitivity analysis, EBUS-TBNA has been shown to have lower cost in comparison with mediastinoscopy.1 Cost utility and health economic analyses from our trial are now being performed, which will provide further insights.

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