OBJECTIVE: The use of endoscopic ultrasound (EUS) with guided fine needle aspiration (FNA) of suspicious lymph nodes has become an important aid in the staging of @entity418 . The economic impact of this staging strategy has not yet been described. We applied a decision analysis model to compare the costs of EUS FNA, CT-guided FNA, and surgery in the management of @entity5 . A cost-minimization approach was employed, as viewed from the perspective of the payer. METHODS: A decision analysis model with three management arms was designed using DATA 3.5 software, taking the entry criteria as @entity418 without evidence of distant @entity3 as determined by CT. Detection of @entity5 on @entity1600 ( @entity1600 ) FNA signified unresectability and prompted palliative treatment: chemoradiotherapy with endoscopic esophageal stenting rather than surgery. Baseline probabilities were varied through plausible ranges using sensitivity analysis. Cost inputs were based on Medicare professional fees plus Medicare facility fees. The endpoint was the cost of management per @entity1 . RESULTS: EUS FNA was the least costly strategy ( 13,811), compared to CT FNA ( 14,350) and surgery ( 13,992). The model outcome was sensitive to changes in both EUS FNA sensitivity and prevalence of @entity1600 @entity3 . EUS FNA remained the least costly option provided the prevalence of @entity1600 involvement was >16%; below this value, surgery became the most economical strategy. CONCLUSION: By minimizing unnecessary surgery, primarily by detecting @entity1600 involvement, EUS FNA is the least costly staging strategy in the workup of @entity1 with nonmetastatic @entity418 . Under certain circumstances, surgery is the preferred strategy.

A cost analysis of endoscopic ultrasound in the evaluation of XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'esophageal tumors'] @entity1600 :: ('MESH:D014388', 'Disease') :: ['CLN', 'celiac lymph node'] @entity418 :: ('MESH:D004938', 'Disease') :: ['esophageal cancer', 'esophageal carcinoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity418 :: (MESH:D004938,Disease) :: ['esophageal cancer']
