Cost-effectiveness analysis of including contrast-enhanced ultrasound in management of pancreatic cystic neoplasms.

Abstract

PURPOSE:

Pancreatic cystic neoplasms (PCN) management consists of non-invasive imaging studies (CT, MRI), with a high resource burden. We aimed to determine the cost-effectiveness of including contrast-enhanced ultrasound (CEUS) in the management of PCN without risk features.

MATERIALS AND METHODS:

By using a decision-tree model in a hypothetical cohort of patients, we compared management strategy including CEUS with the latest Fukuoka consensus, European and Italian guidelines. Our strategy for BD-IPMN/MCN < 1 cm includes 1 CEUS annually. For those between 1 and 2 cm, it includes CEUS 4 times/year during the first year, then 3 times/year for 4 years and then annually. For those between 2 and 3 cm, it comprises MRI twice/year during the first one, then alternating 2 CEUS and 1 MRI yearly.

RESULTS:

CEUS surveillance is the dominant strategy in all scenarios. CEUS surveillance average cost is 1,984.72 €, mean QALY 11.79 and mean ICER 181.99 €. If willingness to pay is 30,000 €, 45% of patients undergone CEUS surveillance of BDIPMN/MCN < 1 cm would be within budget.

CONCLUSION:

Guidelines strategies are very effective, but costs are relatively high from a policy perspective. CEUS surveillance may be a cost-effective strategy yielding a nearly high QALYs, an acceptable ICER, and a lower cost.

• Authors: Niccolo' Faccioli, Elena Santi, Giovanni Foti, Mirko D'Onofrio
• Journal: La Radiologia medica (Radiol Med) Vol. 127 Issue 4 Pg. 349-359 (Apr 2022) ISSN: 1826-6983 [Electronic] Italy
• PMID: 35230618 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Humans
• Cost-Benefit Analysis
• Pancreatic Neoplasms (diagnostic imaging)
• Quality-Adjusted Life Years
• Ultrasonography