Long-term cost-effectiveness of transbronchial lung cryobiopsy in comparison to lung biopsy in the assessment of interstitial lung diseases

<bold>Introduction:</bold> Transbronchial cryobiopsy (TCB) and surgical lung biopsy (SLB) are used to inform the diagnosis in interstitial lung diseases. Both differ in their complications, diagnostic performances, and costs. We aimed to compare their effectiveness and cost-effectiveness from the perspective of a private healthcare provider with long-term thresholds. <bold>Methods:</bold> A literature search was conducted on the efficacy and safety of both techniques, and the quality of life and survival associated with these pathologies. Costs were obtained from hospital cost databases. A decision tree model with a threshold on the patient's median survival, including direct and indirect costs of the procedure, diagnostic yield, complications, survival, quality of life, and long-term medication costs, was developed. Deterministic and probabilistic uncertainty analyses were performed. <bold>Results:</bold> SLB was superior to CB regarding the quality of life adjusted life years (3,54 vs 3,22 QALYs). SLB was more expensive than CB (67376,02 U$D vs 62799,77 U$D). The cost-effectiveness of SLB in comparison to CB was found to be 26.923 U$D per QALY gained. Deterministic analyses found variability associated with diagnostic probabilities, mortality associated with SLB, and quality of life in the setting of misdiagnosis of IPF (Figure 1). Probabilistic analyses demonstrated a significant overlap between strategies and higher acceptability of CB in lower payment thresholds (Figure 2). <bold>Conclusion:</bold> CB seems to be a less expensive alternative to SLB with marginally lower effectiveness, Method selection should consider payer budget, patient preferences, and diagnostic considerations.