Cost-effectiveness of different diagnostic strategies in patients with nonresectable upper gastrointestinal tract malignancies

Background and methods: Using a simple model, this retrospective study eval uated the cost-effectiveness of different diagnostic strategies used for pr etherapeutic detection of patients with disseminated or locally nonresectab le upper gastrointestinal tract malignancies (UGIM). Of 162 consecutive UGI M patients referred for treatment, 73 (45%) had disseminated or locally non resectable disease, and these patients were eligible for evaluation. Results: The noninvasive diagnostic strategies (computed tomography [CT] wi th ultrasonography [US] and endoscopic ultrasonography [EUS]) had a low pro cedure cost, but a diagnostic strategy based on CT with US or CT with US an d laparoscopy was not cost-effective. The inclusion of endoscopic or laparo scopic ultrasonography seemed necessary to the provision of a cost-effectiv e strategy because both techniques had a high diagnostic accuracy combined with a low cost. A change in diagnostic strategy from CT with US to CT with US and EUS resulted in a net saving regarding the cost of each additional nonresectable patient detected, but this strategy still required up to 20% futile explorative laparotomies. Conclusions: The combination of endoscopic and laparoscopic ultrasonography was cost-effective and had no complications in this study. We use this str ategy as our standard in the pretherapeutic evaluation of UGIM patients.