Cost-Effectiveness of a Risk-Tailored Pancreatic Cancer Early Detection Strategy Among Patients With New-Onset Diabetes
| Autor: | Louise Wang, Henry A. Glick, Yu-Xiao Yang, Ben Boursi, Kim A. Reiss, Sankey V. Williams, Frank I. Scott |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Oncology
Adult medicine.medical_specialty endocrine system diseases Cost effectiveness Cost-Benefit Analysis Asymptomatic Willingness to pay Internal medicine Pancreatic cancer Surveillance Epidemiology and End Results Diabetes Mellitus Medicine Humans Stage (cooking) Early Detection of Cancer Hepatology business.industry Gastroenterology Middle Aged medicine.disease Quality-adjusted life year Pancreatic Neoplasms Quality-Adjusted Life Years medicine.symptom business Incremental cost-effectiveness ratio Carcinoma Pancreatic Ductal |
| Zdroj: | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 20(9) |
| ISSN: | 1542-7714 |
| Popis: | Background & Aims Screening for pancreatic ductal adenocarcinoma (PDAC) in asymptomatic adults is not recommended, however, patients with new-onset diabetes (NoD) have an 8 times higher risk of PDAC than expected. A novel risk-tailored early detection strategy targeting high-risk NoD patients might improve PDAC prognosis. We sought to evaluate the cost effectiveness of this strategy. Methods We compared PDAC early detection strategies targeting NoD individuals age 50 years and older at various minimal predicted PDAC risk thresholds vs standard of care in a Markov state–transition decision model under the health care sector perspective using a lifetime horizon. Results At a willingness to pay (WTP) threshold of $150,000 per quality-adjusted life-year, the early detection strategy targeting patients with a minimum predicted 3-year PDAC risk of 1% was cost effective (incremental cost-effectiveness ratio, $116,911). At a WTP threshold of $100,000 per quality-adjusted life-year, the early detection strategy at the 2% risk threshold was cost effective (incremental cost-effectiveness ratio, $63,045). The proportion of PDACs detected at local stage, costs of treatment for metastatic PDAC, utilities of local and regional cancers, and sensitivity of screening were the most influential parameters. Probabilistic sensitivity analysis confirmed that at a WTP threshold of $150,000, early detection at the 1.0% risk threshold was favored (30.6%), followed by the 0.5% risk threshold (20.4%) vs standard of care (1.7%). At a WTP threshold of $100,000, early detection at the 1.0% risk threshold was favored (27.3%) followed by the 2.0% risk threshold (22.8%) vs standard of care (2.0%). Conclusions A risk-tailored PDAC early detection strategy targeting NoD patients with a minimum predicted 3-year PDAC risk of 1.0% to 2.0% may be cost effective. |
| Databáze: | OpenAIRE |
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