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The overall effectiveness and cost of each strategy was a function of the proportion of patients accurately staged and the risks, benefits, and costs of the diagnostic tests and treatments used. Probability estimates and costs were derived from primary data and the literature. We adopted a societal perspective and calculated incremental cost-effectiveness ratios (ICERs) as cost per quality-adjusted life year (QALY) gained.<\/jats:p><jats:p>RESULTS: Both mediastinoscopy strategies correctly identified more patients with mediastinal involvement (N2\/N3 disease) and assigned them to multimodal regimens. Routine mediastinoscopy maximized quality-adjusted life expectancy in all patients, irrespective of T classification, and this result was robust to varying the model estimates over their reported ranges. In T1 patients, selective mediastinoscopy cost $24,500 per QALY gained, compared with $78,800 per QALY gained for routine mediastinoscopy. In T2 and T3 patients, the ICER of routine mediastinoscopy was more favorable ($42,800 and $53,400 per QALY gained, respectively).<\/jats:p><jats:p>CONCLUSION: Routine mediastinoscopy maximizes quality-adjusted life expectancy in patients with known NSCLC, and its ICER compares favorably with other currently accepted medical technologies. The survival benefit and cost-effectiveness of this strategy are greater in patients with T2 and T3 tumors and are likely to improve with advances in multimodal therapy.<\/jats:p>","DOI":"10.1200\/jco.2002.20.1.263","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T00:38:26Z","timestamp":1487896706000},"page":"263-273","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes and Cost-Effectiveness of Alternative Staging Strategies for Non\u2013Small-Cell Lung Cancer"],"prefix":"10.1200","volume":"20","author":[{"given":"Nestor F.","family":"Esnaola","sequence":"first","affiliation":[{"name":"From the Department of Surgery, Brigham and Women\u2019s Hospital, CHASE Management Systems, Partners HealthCare, Inc, and the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia N.","family":"Lazarides","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Brigham and Women\u2019s Hospital, CHASE Management Systems, Partners HealthCare, Inc, and the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Mentzer","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Brigham and Women\u2019s Hospital, CHASE Management Systems, Partners HealthCare, Inc, and the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen M.","family":"Kuntz","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Brigham and Women\u2019s Hospital, CHASE Management Systems, Partners HealthCare, Inc, and the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"R1-099261","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.50.1.7"},{"key":"R2-099261","doi-asserted-by":"publisher","DOI":"10.1378\/chest.89.4_Supplement.225S"},{"key":"R3-099261","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.6.1710"},{"key":"R4-099261","unstructured":"Walliers E, Waters PF: Incidence of mediastinal node involvement in clinical T1 bronchogenic carcinomas. 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