Threshold Analysis of the Cost-effectiveness of Endoscopic Ultrasound in Patients at High Risk for Pancreatic Ductal Adenocarcinoma

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.

Figures

FIGURE 1.

Decision tree model simulating the outcome of a high-risk individual who undergoes screening for pancreatic cancer.

FIGURE 2.

One-way sensitivity analysis evaluating the cost effectiveness of screening by lifetime probability of pancreatic cancer. Below 10.25%, no screening dominates screening.