Cost effectiveness of EUS for preoperative localization of pancreatic endocrine tumors

Background: Endoscopic ultrasonography (EUS) is highly accurate in the loca lization of small pancreatic tumors. We determined the cost effectiveness o f EUS used early in the preoperative evaluation of pancreatic endocrine tum ors. Methods: In a study with a case-control design, 36 patients (19 men, 17 wom en) who underwent preoperative EUS were matched retrospectively with 36 pat ients who underwent surgical exploration immediately before the introductio n of EUS. The number, cost, and effectiveness of preoperative localization studies, days of hospitalization, and surgical and anesthesia times were as sessed. Results: The EUS group had reduced charges for preoperative localization st udies: $2620 versus $4846 per patient (p < 0.05), largely because of reduct ions in the number of diagnostic angiograms and venous sampling procedures performed. Surgical and total anesthesia times were decreased, as were the number of preoperative admissions for angiographic procedures. The cost-eff ectiveness ratio for the EUS group was $3144 per tumor localized compared w ith $5628 per tumor localized for the group treated before EUS became avail able (p < 0.05). Conclusion: EUS is highly accurate in the localization of pancreatic neuroe ndocrine tumors and is cost effective when used early in the preoperative l ocalization strategy. EUS decreased the need for additional invasive tests and avoided unnecessary morbidity and resource consumption. EUS should play a primary role in preoperative localization of pancreatic neuroendocrine t umors.