Table 3 Summary table of the structure of the three economics papers included in the review

Shumaker et al. (2002) [26], USA.

To determine (1) the relative proportions of each oesophageal cancer stage in a group of patients referred for preoperative staging with EUS, (2) the proportion of patients with EUS stage 1 and 4 tumours that would not be treated with combined modality therapy, and

(3) to estimate the potential cost savings of performing preoperative EUS in oesophageal cancer patients.

Patients with oesophageal cancer receiving preoperative staging with EUS (n = 180, 82% men and mean age 66.5 years).

Cost analysis using a retrospective review of a large multicentre national computerised endoscopic database. Data between February 1998 and October 2000 were extracted, reviewed and analysed.

Not stated specifically, the authors described US Medicare data

Price year: 2000

Currency: US dollars (USD$)

NA: retrospective review of a large national endoscopic database.

NA

NA

The cost of EUS for preoperative staging of oesophageal cancer was estimated at $634 per patient (£697 per patient, 2017 price year)

Cost analysis study: the potential cost savings of performing preoperative EUS in oesophageal cancer patients.

Preoperative staging of oesophageal cancer with EUS can facilitate cost savings by reducing the need for additional treatments in stage 1 and 4 oesophageal cancer (a significant proportion of patients – 26% in this series).

Chang et al. (2003) [27], USA

To determine the impact of EUS combined with FNA on patients’ choice of therapy and on the cost of care.

Patients diagnosed with oesophageal cancer (squamous-cell or adenocarcinoma) who were referred to the University of California’s Irvine Medical Center for preoperative EUS staging between August 1993 and August 1997 (n = 60, 39 men, 21 women and mean age 68 ± 10 years). These patients were all being considered for surgical resection and had undergone standard evaluation including CT which showed no evidence of distant metastases.

Cost analysis alongside prospective case series.

Not stated specifically, the study was undertaken in California, USA.

Not stated specifically, the authors described their cost analyses were based on the published direct costs of endosonography-guided aspiration biopsy and thoracotomy published in 1997 (Gress et al., 1997).

Currency: US dollars (USD$)

NA: cost analysis study alongside prospective case series.

NA

Based on the data used in the cost analyses, the length of follow-up was, on average, 17 months (range 1–51 months).

The cost of EUS-FNA biopsy based on the published direct costs of endosonography-guided aspiration biopsy (Gress et al., 1997) was estimated at $1975 per patient (outpatient) (£3528 per patient, 2017 price year).

Cost analysis study: the cost of care for these patients was calculated to explore whether or not the use of EUS decreases the cost of managing patients with oesophageal cancer.

Patients’ decisions on whether to undergo medical or surgical treatment correlated significantly with their overall tumour staging, suggesting that the information provided by EUS played a significant role in patients’ decision-making. EUS-guided therapy potentially reduces the cost of managing patients with oesophageal cancer by USD$12,340 per patient (£10,510 per patient, 2017 price year) due to reduced number of thoracotomies undertaken (patient choice).

Russell et al. (2013) [11], UK

To examine whether the addition of EUS to usual staging uses resources cost-effectively.

Patients with proven cancer of the oesophagus, stomach or gastro-oesophageal junction; medically fit for both surgery (even if not planned) and chemotherapy, free of metastatic disease and had not started treatment. Both their ASA (America Society of Anesthesiologists) grading and their WHO performance status had to be 1 or 2 (n = 213, 165 male; mean age 64.4 years; EUS group (n = 107); No EUS group (n = 106)).

Cost-effectiveness analysis alongside a multi-centre randomised controlled trial (RCT) namely ‘COGNATE trial’. The study explored whether giving EUS scan in addition to standard staging algorithms would be more cost-effective compared to standard staging algorithms.

NHS perspective, focusing on health-care resources used by participants including investigation, treatment and palliation, and other elements of secondary and pharmaceutical care.

Price year 2008

Currency: Pounds Sterling (£)

Cancer staging with EUS vs. without EUS

Patients randomised to intervention group received EUS scan in addition to standard staging algorithms. Patients randomised to control group received standard staging algorithms.

Study follow-up period was 54 months or until death, whichever came first. Main analyses of the study (including health economic analysis) used 48 months.

The cost of EUS scan was £551 (day case) (£648, 2017 price year), £1477 (outpatient) (£1737, 2017 price year) and £3781 (inpatient) (£4447, 2017 price year).

Cost-effectiveness analysis using QALY as a measure of effect – The difference in cost and QALY between intervention and control groups was calculated; the probabilities of the EUS intervention being cost-effective at different willingness-to-pay thresholds were estimated.

EUS reduced net use of health-care resources by £2860 (£3364, 2017 price year) and had an increase of 0.1969 in estimated mean QALYs. Combining these estimated benefits and savings yields probability of 96.6% that EUS is cost-effective in the sense of achieving the NICE criterion of costing less than £20,000 to gain a QALY [28].