Abstract
Simple SummaryThe incidence of IPMN is increasing, mainly attributed to the expanded application of radiological cross-sectional imaging and improvements in image quality. IPMN are the cause of approximately 10% of all pancreatectomies in the USA. A significant number of surgically treated IPMNs do not show high-grade dysplasia or invasive cancer, raising the question of overtreatment, and the need for better diagnostic accuracy. 18F-FDG-PET/CT demonstrated promising diagnostic performance in the detection of malignant transformation of IPMN in comparison to CT and MRI. In this study, the authors analyze whether a supplemental 18F-FDG-PET/CT to the current diagnostic pathway of IPMN could be cost-effective. Results suggest that implementation of 18F-FDG-PET/CT in a preoperative setting could be beneficial from a health care system perspective. It also encourages the research community to investigate if 18F-FDG-PET/CT could be a useful addition in other diagnostic settings within IPMN management.Accurate detection of malignant transformation and risk-stratification of intraductal papillary mucinous neoplasms (IPMN) has remained a diagnostic challenge. Preliminary findings have indicated a promising role of positron emission tomography combined with computed tomography and 18F-fluorodeoxyglucose (18F-FDG-PET/CT) in detecting malignant IPMN. Therefore, the aim of this model-based economic evaluation was to analyze whether supplemental FDG-PET/CT could be cost-effective in patients with IPMN. Decision analysis and Markov modeling were applied to simulate patients’ health states across a time frame of 15 years. CT/MRI based imaging was compared to a strategy with supplemental 18F-FDG-PET/CT. Cumulative costs in US-$ and outcomes in quality-adjusted life years (QALY) were computed based on input parameters extracted from recent literature. The stability of the model was evaluated by deterministic sensitivity analyses. In the base-case scenario, the CT/MRI-strategy resulted in cumulative discounted costs of USD $106,424 and 8.37 QALYs, while the strategy with supplemental FDG-PET/CT resulted in costs of USD $104,842 and a cumulative effectiveness of 8.48 QALYs and hence was cost-saving. A minimum specificity of FDG-PET/CT of 71.5% was required for the model to yield superior net monetary benefits compared to CT/MRI. This model-based economic evaluation indicates that supplemental 18F-FDG-PET/CT could have a favorable economic value in the management of IPMN and could be cost-saving in the chosen setting. Prospective studies with standardized protocols for FDG-PET/CT could help to better determine the value of FDG-PET/CT.
Highlights
Intraductal papillary mucinous neoplasms (IPMN) are intrapancreatic mucinous cystic lesions with potential of malignant transformation [1]
IPMN are categorized in main duct, branch duct, and mixed type IPMN, each of which is associated with a different risk of malignant change and potential to develop pancreatic ductal adenocarcinoma (PDAC), associated with 5-year survival rates as low as 6% [6,7]
When specificity of 18F-FDG-PET/computed tomography (CT) was reduced below 71.5%, the strategy no longer provided an advantage in terms of net monetary benefit
Summary
Intraductal papillary mucinous neoplasms (IPMN) are intrapancreatic mucinous cystic lesions with potential of malignant transformation [1]. IPMN are categorized in main duct, branch duct, and mixed type IPMN, each of which is associated with a different risk of malignant change and potential to develop pancreatic ductal adenocarcinoma (PDAC), associated with 5-year survival rates as low as 6% [6,7]. The three current international guidelines for the management of cystic tumors of the pancreas define slightly differing pathways for therapeutic management and surveillance options with regard to IPMN [1,8,9]. For the surveillance of asymptomatic IPMN without worrisome features, different imaging modalities and follow-up intervals have been proposed with contrast-enhanced magnetic resonance imaging (MRI) including magnetic resonance cholangiopancreatography (MRCP) as the modality of choice [1]. Contrast-enhanced MRI with MRCP provides high diagnostic accuracy for the differentiation of cystic lesions of the pancreas for the depiction of continuity to the pancreatic duct. Guidelines recommend computed tomography (CT) imaging as an alternative
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