Abstract
Abstract
Objective
Pancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer.
Methods
A decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed.
Results
In the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters.
Conclusion
Based on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer.
Key Points
• Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness.
• The economic model showed high robustness for varying input parameters.
Funder
Technische Universität München
Publisher
Springer Science and Business Media LLC
Subject
Radiology Nuclear Medicine and imaging,General Medicine
Reference37 articles.
1. Rawla P, Sunkara T, Gaduputi V (2019) Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 10:10–27. https://doi.org/10.14740/wjon1166
2. Howlader N, Noone AM, Krapcho M et al (2020) SEER Cancer Statistics Review, 1975-2018, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2018/, based on November 2020 SEER data submission
3. da Costa WL, Oluyomi AO, Thrift AP (2020) Trends in the incidence of pancreatic adenocarcinoma in all 50 United States Examined Through An Age-Period-Cohort Analysis. JNCI Cancer Spectr 4:1–7. https://doi.org/10.1093/jncics/pkaa033
4. Pugalenthi A, Protic M, Gonen M et al (2016) Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol 113:188–193. https://doi.org/10.1002/jso.24125
5. Glasgow RE, Jackson HH, Neumayer L et al (2007) Pancreatic resection in veterans affairs and selected university medical centers: results of the patient safety in surgery study. J Am Coll Surg 204:1252–1260. https://doi.org/10.1016/j.jamcollsurg.2007.03.015
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献