TY - JOUR
T1 - Cost-effectiveness of Pancreatic Cancer Surveillance in High-Risk Individuals
T2 - An Economic Analysis
AU - Corral, Juan E.
AU - Das, Ananya
AU - Bruno, Marco J.
AU - Wallace, Michael B.
N1 - Funding Information:
Abbreviations: CMS - Center for Medicare Services, DM - Diabetes mell, EUS - Endoscopic ultrasound, FNA - Fine needle aspiration, FPC - Familial pancreatic cancer, HP - Hereditary pancreatitis, HRI - High risk individuals, ICER - Incremental cost-effectiveness ratio, INHB - Incremental net health benefit, MRI - Magnetic resonance imaging, NHB - Net health benefit, PJS - Peutz-Jeghers syndrome, QALY-Quality adjusted life years, RR - Relative risk, From the *Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; †Center for Digestive Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; and ‡Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands. Received for publication September 20, 2018; accepted January 30, 2019. Address correspondence to: Michael B. Wallace, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic, Florida, 4500 San Pablo Rd, Jacksonville, FL (e‐mail: Wallace.michael@mayo.edu). J.E.C. drafted the article, provided estimates, and assisted on statistical analysis. A.D. did the conception and study design, conducted modeling and statistical analysis, critically reviewed the article. M.J.B. reviewed estimates and critically reviewed the article. M.B.W. did the conception and study design, advised on statistical analysis, and critically reviewed the article. Programmatic support for pancreatic cancer research was provided by the Florida Pancreatic Cancer Coalition and the Champions for Hope charitable organizations. The authors declare no conflict of interests. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pancreasjournal.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000001268
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Objective The aim of the study was to perform an economic analysis to identify the clinical and cost determinants of pancreatic cancer (PC) surveillance in high-risk individuals (HRIs). Methods A Markov model was created to compare the following 3 strategies: no screening, endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) screening. Patients were considered HRIs according to the Cancer of the Pancreas Screening consortium recommendations. Risk for developing PC, survival, and costs data were obtained from the Surveillance, Epidemiology, and End Results and Medicare databases. Surveillance effectiveness was obtained from a recent meta-analysis. Results Analysis of a cohort with fivefold relative risk of PC higher than the US population showed that MRI is the most cost-effective strategy. For those with the highest risk (>×20 relative risk), EUS became the dominant strategy. Our model was impacted by cost and imaging performance, but still cost-effective within the range reported in literature. Threshold analysis showed that if MRI increases greater than US $1600, EUS becomes more cost-effective. Once patients reached the age of 76 years, "no screening" was favored. Both surveillance strategies were cost-effective over a wide range of willingness to pay. Conclusions Abdominal imaging followed by pancreatectomy is cost-effective to prevent PC in HRIs, favoring MRI in moderate risk cases but EUS in those with highest risk.
AB - Objective The aim of the study was to perform an economic analysis to identify the clinical and cost determinants of pancreatic cancer (PC) surveillance in high-risk individuals (HRIs). Methods A Markov model was created to compare the following 3 strategies: no screening, endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) screening. Patients were considered HRIs according to the Cancer of the Pancreas Screening consortium recommendations. Risk for developing PC, survival, and costs data were obtained from the Surveillance, Epidemiology, and End Results and Medicare databases. Surveillance effectiveness was obtained from a recent meta-analysis. Results Analysis of a cohort with fivefold relative risk of PC higher than the US population showed that MRI is the most cost-effective strategy. For those with the highest risk (>×20 relative risk), EUS became the dominant strategy. Our model was impacted by cost and imaging performance, but still cost-effective within the range reported in literature. Threshold analysis showed that if MRI increases greater than US $1600, EUS becomes more cost-effective. Once patients reached the age of 76 years, "no screening" was favored. Both surveillance strategies were cost-effective over a wide range of willingness to pay. Conclusions Abdominal imaging followed by pancreatectomy is cost-effective to prevent PC in HRIs, favoring MRI in moderate risk cases but EUS in those with highest risk.
KW - Abbreviations
KW - CMS-Center for Medicare Services
KW - DM-Diabetes mell
KW - EUS-Endoscopic ultrasound
KW - FNA-Fine needle aspiration
KW - FPC-Familial pancreatic cancer
KW - HP-Hereditary pancreatitis
KW - HRI-High risk individuals
KW - ICER-Incremental cost-effectiveness ratio
KW - INHB-Incremental net health benefit
KW - MRI-Magnetic resonance imaging
KW - NHB-Net health benefit
KW - PJS-Peutz-Jeghers syndrome
KW - QALY-Quality adjusted life years
KW - RR-Relative risk
KW - SEER-National Cancer Institute-Surveillance, epidemiology, and end results program
KW - abdominal imaging
KW - high-risk individuals
KW - pancreatic cancer
KW - screening
KW - surveillance
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U2 - 10.1097/MPA.0000000000001268
DO - 10.1097/MPA.0000000000001268
M3 - Article
C2 - 30946242
AN - SCOPUS:85064189900
VL - 48
SP - 526
EP - 536
JO - Pancreas
JF - Pancreas
SN - 0885-3177
IS - 4
ER -