Threshold Analysis of the Cost-effectiveness of Endoscopic Ultrasound in Patients at High Risk for Pancreatic Ductal Adenocarcinoma
Shria Kumar, Monica Saumoy, Aaron Oh, Yecheskel Schneider, Randall E Brand, Amitabh Chak, Gregory G Ginsberg, Michael L Kochman, Marcia Irene Canto, Michael Gilbert Goggins, Chin Hur, Fay Kastrinos, Bryson W Katona, Anil K Rustgi, Shria Kumar, Monica Saumoy, Aaron Oh, Yecheskel Schneider, Randall E Brand, Amitabh Chak, Gregory G Ginsberg, Michael L Kochman, Marcia Irene Canto, Michael Gilbert Goggins, Chin Hur, Fay Kastrinos, Bryson W Katona, Anil K Rustgi
Abstract
Objectives: Data from the International Cancer of the Pancreas Screening Consortium studies have demonstrated that screening for pancreatic ductal adenocarcinoma can be effective and that surveillance improves survival in high-risk individuals. Endoscopic ultrasound (EUS) and cross-sectional imaging are both used, although there is some suggestion that EUS is superior. Demonstration of the cost-effectiveness of screening is important to implement screening in high-risk groups.
Methods: Results from centers with EUS-predominant screening were pooled to evaluate efficacy of index EUS in screening. A decision analysis model simulated the outcome of high-risk patients who undergo screening and evaluated the parameters that would make screening cost-effective at a US $100,000 per quality-adjusted life-year willingness to pay.
Results: One-time index EUS has a sensitivity of 71.25% and specificity of 99.82% to detection to detect high-risk lesions. Screening with index EUS was cost-effective, particularly at lifetime pancreatic cancer probabilities of greater than 10.8%, or at lower probabilities if life expectancy after resection of a lesion that was at least 16 years, and if missed, lesion rates on index EUS are 5% or less.
Conclusions: Pancreatic cancer screening can be cost-effective through index EUS, particularly for those individuals at high-lifetime risk of cancer.
Trial registration: ClinicalTrials.gov NCT02000089.
Conflict of interest statement
S.K. received travel support from the Boston Scientific Corporation and Olympus. B.W.K, is a consultant of Exact Sciences and received travel support from Janssen. M.L.K. is a consultant of Boston Scientific, Olympus, and Pentax. Equity MAB: Dark Canyon Laboratories, VIRGO. The other authors declare no conflict of interest.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Source: PubMed