Cost-effectiveness of Pancreatic Cancer Surveillance in High-Risk Individuals: An Economic Analysis
Abstract
Objective: The aim of the study was to perform an economic analysis to identify the clinical and cost determinants of pancreatic cancer (PC) surveillance in high-risk individuals (HRIs). Methods: A Markov model was created to compare the following 3 strategies: no screening, endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) screening. Patients were considered HRIs according to the Cancer of the Pancreas Screening consortium recommendations. Risk for developing PC, survival, and costs data were obtained from the Surveillance, Epidemiology, and End Results and Medicare databases. Surveillance effectiveness was obtained from a recent meta-analysis. Results: Analysis of a cohort with fivefold relative risk of PC higher than the US population showed that MRI is the most cost-effective strategy. For those with the highest risk (>×20 relative risk), EUS became the dominant strategy. Our model was impacted by cost and imaging performance, but still cost-effective within the range reported in literature. Threshold analysis showed that if MRI increases greater than US $1600, EUS becomes more cost-effective. Once patients reached the age of 76 years, “no screening” was favored. Both surveillance strategies were cost-effective over a wide range of willingness to pay. Conclusions: Abdominal imaging followed by pancreatectomy is cost-effective to prevent PC in HRIs, favoring MRI in moderate risk cases but EUS in those with highest risk.
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Using a cost-effectiveness perspective, no screening is favored once patients reach the age of 75 years.
“There is no agreement on the age to stop screening, but using a cost-effectiveness perspective, no screening is favored once patients reach the age of 75 years.79”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [79]
Germline mutation carriers have double the risk of neoplastic progression compared with FPC relatives without a mutation.
“The risk category of the HRI should also be considered: germline mutation carriers have double the risk of neoplastic progression compared with FPC relatives without a mutation.78”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [78]
Abdominal imaging followed by pancreatectomy of screen-detected lesions is cost-effective as a preventive measure to prevent PDAC.
“If cost-effectiveness of surveillance of HRI is considered, abdominal imaging followed by pancreatectomy of screen-detected lesions is cost-effective as a preventive measure to prevent PDAC.79”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [79]
In a Markov model-based cost-effectiveness analysis comparing no screening, EUS, and MRI for screening of HRI, for a cohort with a 5-fold relative risk of PDAC higher than the general US population, MRI was the most cost-effective strategy.
“In a Markov model–based cost-effectiveness analysis comparing no screening, EUS, and MRI for screening of HRI, analysis of a cohort with a 5-fold relative risk of PDAC higher than the general US population (“moderate risk group” defined above), MRI was the most cost-effective strategy.”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [79]
If MRI is more costly than US $1600, EUS becomes more cost-effective.
“Furthermore, the cost of MRI and EUS can vary, and if MRI is more costly than US $1600, EUS becomes more cost-effective.”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [79]
In HRIs with >20-fold relative risk, EUS became the dominant strategy.
“However, in HRIs with >20-fold relative risk (the “intermediate high risk” and “very high risk” group), EUS became the dominant strategy.79”
From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [79]
Cost-effectiveness models for pancreatic surveillance have been published.
“Cost-effectiveness models of pancreatic surveillance have been reported.”
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- Authors
- Corral, J. E., Das, A., Bruno, M. J., & Wallace, M. B.
- Affiliations
- Mayo Clinic in Florida (US)
- St. Joseph's Hospital and Medical Center (US)
- Erasmus MC (NL)
- Corresponding author
- Corral, Juan E.
- Wallace, Michael B.
- Venue
- Pancreas
- Published
- 2019-04
- Volume
- 48
- Issue
- 4
- Pages
- 526-536
- ISSN
- 0885-3177 (ISSN-L)
- 1536-4828
- OpenAlex
- W2933216979
- Cited by
- 66
- References
- 43
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 10 · 2023: 11 · 2022: 14 · 2021: 11 · 2020: 5 · 2019: 3
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pancreas (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- pancreatic cancer, cancer surveillance, high-risk individuals, cost-effectiveness, endoscopic ultrasound, magnetic resonance imaging, cancer screening, pancreatic resection, relative risk, threshold analysis, willingness to pay
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Female, Humans, Magnetic Resonance Imaging, Male, Mass Screening, Middle Aged, Pancreatic Neoplasms, Population Surveillance, Risk Factors, Models, Economic, Endosonography, Early Detection of Cancer
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