Cost-Effectiveness Analysis of Screening for Pancreatic Cancer Among High-Risk Populations.

Autor:	Peters MLB; Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA., Eckel A; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA., Seguin CL; Department of Radiology, The Ohio State University College of Medicine, Columbus, OH., Davidi B; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA., Howard DH; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA., Knudsen AB; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.; Department of Radiology, Massachusetts General Hospital, Boston, MA., Pandharipande PV; Department of Radiology, The Ohio State University College of Medicine, Columbus, OH.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2024 Feb; Vol. 20 (2), pp. 278-290. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1200/OP.23.00495
Abstrakt:	Purpose: We evaluated the potential cost-effectiveness of combined magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) screening for pancreatic ductal adenocarcinoma (PDAC) among populations at high risk for the disease. Methods: We used a microsimulation model of the natural history of PDAC to estimate the lifetime health benefits, costs, and cost-effectiveness of PDAC screening among populations with specific genetic risk factors for PDAC, including BRCA1 and BRCA2 , PALB2 , ATM , Lynch syndrome, TP53 , CDKN2A , and STK11 . For each high-risk population, we simulated 29 screening strategies, defined by starting age and frequency. Screening included MRI with follow-up EUS in a subset of patients. Costs of tests were based on Medicare reimbursement for MRI, EUS, fine-needle aspiration biopsy, and pancreatectomy. Cancer-related cost by stage of disease and phase of treatment was based on the literature. For each high-risk population, we performed an incremental cost-effectiveness analysis, assuming a willingness-to-pay (WTP) threshold of $100,000 US dollars (USD) per quality-adjusted life year (QALY) gained. Results: For men with relative risk (RR) 12.33 ( CDKN2A ) and RR 28 ( STK11 ), annual screening was cost-effective, starting at age 55 and 40 years, respectively. For women, screening was only cost-effective for those with RR 28 ( STK11 ), with annual screening starting at age 45 years. Conclusion: Combined MRI/EUS screening may be a cost-effective approach for the highest-risk populations (among mutations considered, those with RR >12). However, for those with moderate risk (RR, 5-12), screening would only be cost-effective at higher WTP thresholds (eg, $200K USD/QALY) or with once-only screening.
Databáze:	MEDLINE
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