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

Niccolo’ Faccioli,Mirko D’Onofrio,Giovanni Foti,Elena Santi

doi:10.1007/s11547-022-01459-8

Abstract

PurposePancreatic 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 methodsBy 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.ResultsCEUS 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.ConclusionGuidelines 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.

Highlights

Pancreatic cystic neoplasms (PCN) are closed cavities, usually containing liquid or mucinous material; their prevalence in asymptomatic individuals is estimated to be 8% [1], and represent a heterogeneous group of tumours, each of them with typical biological behaviour
Over 90% of incidental PCN can be categorized as serous cystic neoplasm (SCN), intraductal papillary neoplasm (IPMN) or mucinous cystic neoplasm (MCN)
The results of our analysis suggest that a strategy based on contrast-enhanced ultrasound (CEUS) appears to be cost-effective in managing incidental asymptomatic PCN, in the surveillance of MCN/BD-IPMN with size < 1 cm

Summary

Introduction

Pancreatic cystic neoplasms (PCN) are closed cavities, usually containing liquid or mucinous material; their prevalence in asymptomatic individuals is estimated to be 8% [1], and represent a heterogeneous group of tumours, each of them with typical biological behaviour. SCN represents 10–16% of cystic pancreatic neoplasms, they are benign in most the cases, and should. For MCN measuring < 40 mm without a mural nodule or symptoms, surveillance with MRI, EUS or a combination of both is recommended [11–13]. Cystic lesions management consists on non-invasive imaging studies (CT, MRI) according to the last recommendations [10–13]; and by more invasive tests such as Endoscopic US (EUS) [14]. Some studies have shown that diagnostic accuracy of CEUS is analogous to MRI in the detection of septa and mural nodules of PCNs and can reveal vegetations’ enhancement [15–21]. Base-case Annual decrease (aging) Instant decrease (Symptoms) Quality of life (utility) of undergoing invasive surveillance Quality of life (utility) of undergoing non-invasive surveillance Quality of life (utility) of developing malignant pancreatic cyst.

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