Abstract
ObjectivePancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer.MethodsA decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed.ResultsIn the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters.ConclusionBased on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer.Key Points• Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness.• The economic model showed high robustness for varying input parameters.
Highlights
Pancreatic cancer is an exceptionally aggressive tumor entity with the lowest 5-year survival rate of all solid tumors [1]
The detection of liver metastases is of particular importance as they are the most frequent metastases and an exclusion criterion for surgical resection and its associated costs and complications
We show that CE-MR/CT is a cost-effective diagnostic strategy in staging pancreatic cancer
Summary
Pancreatic cancer is an exceptionally aggressive tumor entity with the lowest 5-year survival rate of all solid tumors [1]. The detection rate of liver metastases in computed tomography is described in the literature with a sensitivity of 70 to 76% [9, 10]. Contrast-enhanced MRI is frequently described as an alternative for assessing the locoregional extent and detecting lymph node and liver metastases. It appears to be dominant over contrastenhanced computed tomography (CE-CT) in detecting liver lesions, with a sensitivity of 90 to 97% [11, 12]. Additional MR imaging during the staging of pancreatic cancer was shown to reduce resection rates, indicating that patients in a metastatic stage who received staging with CE-CT were resected incorrectly [13]
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